Provider Demographics
NPI:1245429489
Name:HERINGTON, JOHN RICHARD (MSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RICHARD
Last Name:HERINGTON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62573-0030
Mailing Address - Country:US
Mailing Address - Phone:217-233-1327
Mailing Address - Fax:217-233-1328
Practice Address - Street 1:2490 N WATER ST
Practice Address - Street 2:SUITE 1
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4251
Practice Address - Country:US
Practice Address - Phone:217-233-1327
Practice Address - Fax:217-233-1328
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-17211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILKO4522Medicare UPIN
IL208521Medicare PIN