Provider Demographics
NPI:1508821893
Name:HUMENICK, WALTER PETER (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:PETER
Last Name:HUMENICK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 78
Mailing Address - Street 2:BOX 7362
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96326
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PSC 78
Practice Address - Street 2:BOX 7362
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96326
Practice Address - Country:JP
Practice Address - Phone:08-034-8271
Practice Address - Fax:0-803-4271
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-11409101YA0400X
AZLCSW-108171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical