Provider Demographics
NPI:1407058415
Name:HEADMAN, NEIL C (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:C
Last Name:HEADMAN
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2534 FARRAGUT DR STE 2
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-1466
Mailing Address - Country:US
Mailing Address - Phone:217-953-4660
Mailing Address - Fax:888-972-6419
Practice Address - Street 1:2534 FARRAGUT DR STE 2
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704
Practice Address - Country:US
Practice Address - Phone:217-953-4660
Practice Address - Fax:888-972-6419
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0118481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical