Provider Demographics
NPI:1972992576
Name:W. JOSEPH HAMBOR LISW-S
Entity Type:Organization
Organization Name:W. JOSEPH HAMBOR LISW-S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HAMBOR
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:614-787-3843
Mailing Address - Street 1:5 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-1210
Mailing Address - Country:US
Mailing Address - Phone:614-787-3843
Mailing Address - Fax:614-321-6253
Practice Address - Street 1:5 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-1210
Practice Address - Country:US
Practice Address - Phone:614-787-3843
Practice Address - Fax:614-321-6253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0003808261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9111115Medicaid
SW35281OtherMEDICARE PTAN