Provider Demographics
NPI:1881742930
Name:WORD, DAVID LEE (LCSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:WORD
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 1:5360 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-1353
Mailing Address - Country:US
Mailing Address - Phone:219-362-2145
Mailing Address - Fax:219-862-1143
Practice Address - Street 1:41230 STATE ROAD 2 W
Practice Address - Street 2:SUITE B
Practice Address - City:LAPORTE
Practice Address - State:IN
Practice Address - Zip Code:46350
Practice Address - Country:US
Practice Address - Phone:219-862-2145
Practice Address - Fax:219-362-1143
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99023274A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN485380Medicare ID - Type UnspecifiedSWANSON CENTER