NPIMap

Organization Active NPI

Willowglen Academy-in, Inc

  • Psychiatry Physician
  • Gary, IN
National Provider Identifier
1972933349
Registry record updated Nov 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
0103158A Issued in IN
Legal business name
WILLOWGLEN ACADEMY-IN, INC
Practice address
4955 Broadway
Gary, IN 46409-2706
Phone
(219) 886-1320
NPI assigned
Nov 20, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Catherine Anderson, LCSW, LCAC
Title
Clinical Manager
Phone
(219) 886-1320

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 344004861A IN
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 34002639A IN
Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163W00000X 28072804A IN
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X 0103158A IN Primary

Addresses

Primary practice location

4955 Broadway
Gary, IN 46409-2706

Mailing address

308 E 21St Ave
Gary, IN 46407-2618
Phone (219) 886-1320

Other identifiers 1

IdentifierTypeStateIssuer
200185860MedicaidIN

National Provider Directory

National Provider Directory
Tax ID family
Willowglen Academy - Indiana6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4955 Broadway
Gary, IN 46409
Phone (219) 886-1320

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1384905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384905600000",
    "number": "1972933349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 E 21ST AVE",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464072618",
            "telephone_number": "219-886-1320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4955 BROADWAY",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464092706",
            "telephone_number": "219-886-1320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOWGLEN ACADEMY-IN, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-20",
        "last_updated": "2013-11-20",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "CATHERINE",
        "authorized_official_title_or_position": "CLINICAL MANAGER",
        "authorized_official_telephone_number": "219-886-1320",
        "authorized_official_credential": "LCSW, LCAC"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "344004861A",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34002639A",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28072804A",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "0103158A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200185860",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gary, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.