Provider Demographics
NPI:1902900400
Name:BADAMI, PETER ALFRED (LISW)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ALFRED
Last Name:BADAMI
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 E ALTA VISTA
Mailing Address - Street 2:ORHC CLINICS CLINIC BILLING
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501
Mailing Address - Country:US
Mailing Address - Phone:641-684-3053
Mailing Address - Fax:641-683-2855
Practice Address - Street 1:312 E ALTA VISTA
Practice Address - Street 2:BEHAVIORAL HEALTH COUNSELING SERVICES
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501
Practice Address - Country:US
Practice Address - Phone:641-684-3138
Practice Address - Fax:641-684-3198
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00401104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI18884Medicare PIN