1992804314 NPI number — MR. JAMES PARKER WARD LCSW

Table of content: MR. JAMES PARKER WARD LCSW (NPI 1992804314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992804314 NPI number — MR. JAMES PARKER WARD LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARD
Provider First Name:
JAMES
Provider Middle Name:
PARKER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
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:
1992804314
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
925 CENTRAL AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEERFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60015-4212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-421-4900
Provider Business Mailing Address Fax Number:
847-948-8681

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
464 CENTRAL AVENUE
Provider Second Line Business Practice Location Address:
SUITE 30
Provider Business Practice Location Address City Name:
NORTHFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60093-3040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-421-4900
Provider Business Practice Location Address Fax Number:
847-948-8681
Provider Enumeration Date:
09/22/2006

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: 104100000X , 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: 0001633784 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com