Healthcare Provider Details

I. General information

NPI: 1972992576
Provider Name (Legal Business Name): W. JOSEPH HAMBOR LISW-S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 W CHURCH ST
PICKERINGTON OH
43147-1210
US

IV. Provider business mailing address

5 W CHURCH ST
PICKERINGTON OH
43147-1210
US

V. Phone/Fax

Practice location:
  • Phone: 614-787-3843
  • Fax: 614-321-6253
Mailing address:
  • Phone: 614-787-3843
  • Fax: 614-321-6253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberI0003808
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberI0003808
License Number StateOH

VIII. Authorized Official

Name: MR. WILLIAM JOSEPH HAMBOR
Title or Position: PRESIDENT/OWNER
Credential: LISW-S
Phone: 614-787-3843