Healthcare Provider Details

I. General information

NPI: 1881742930
Provider Name (Legal Business Name): DAVID LEE WORD LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41230 STATE ROAD 2 W SUITE B
LAPORTE IN
46350
US

IV. Provider business mailing address

5360 LINCOLN ST
MERRILLVILLE IN
46410-1353
US

V. Phone/Fax

Practice location:
  • Phone: 219-862-2145
  • Fax: 219-362-1143
Mailing address:
  • Phone: 219-362-2145
  • Fax: 219-862-1143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number99023274A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: