1780736843 NPI number — MR. MICHAEL J. PEARSON MSW, LCSW

Table of content: MR. MICHAEL J. PEARSON MSW, LCSW (NPI 1780736843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780736843 NPI number — MR. MICHAEL J. PEARSON MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEARSON
Provider First Name:
MICHAEL
Provider Middle Name:
J.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780736843
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
765 ELA RD
Provider Second Line Business Mailing Address:
SUITE 211
Provider Business Mailing Address City Name:
LAKE ZURICH
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60047-6305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-438-5336
Provider Business Mailing Address Fax Number:
847-540-0958

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
765 ELA RD
Provider Second Line Business Practice Location Address:
SUITE 211
Provider Business Practice Location Address City Name:
LAKE ZURICH
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60047-6305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-438-5336
Provider Business Practice Location Address Fax Number:
847-540-0958
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  149004449 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2154749 . This is a "AETNA PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0005204094 . This is a "AETNA PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 05959 . This is a "CIGNA BEHAVIORAL HEALTH #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0004932116 . This is a "BLUE CROSS BLUE SHIELD PN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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