Provider Demographics
NPI:1669773552
Name:WARD, JIHAN S (LCSW)
Entity type:Individual
Prefix:MS
First Name:JIHAN
Middle Name:S
Last Name:WARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MAIN STREET
Mailing Address - Street 2:3
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832
Mailing Address - Country:US
Mailing Address - Phone:603-858-4603
Mailing Address - Fax:
Practice Address - Street 1:186 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4436
Practice Address - Country:US
Practice Address - Phone:603-858-4603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MA218262104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1669773552Medicaid
NH1669773552Medicaid