Provider Demographics
NPI:1346370418
Name:WEBB, EARNEST JR (MSW PHD)
Entity type:Individual
Prefix:DR
First Name:EARNEST
Middle Name:
Last Name:WEBB
Suffix:JR
Gender:M
Credentials:MSW PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 MAPLE AVE.
Mailing Address - Street 2:903
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2068
Mailing Address - Country:US
Mailing Address - Phone:708-799-5862
Mailing Address - Fax:708-799-0138
Practice Address - Street 1:849 MAPLE AVE.
Practice Address - Street 2:903
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2068
Practice Address - Country:US
Practice Address - Phone:708-799-5862
Practice Address - Fax:708-799-0138
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490058991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001605394OtherBLUE CROSS BLUE SHEILD #
IL182725OtherVALUE OPTION PROVIDER #
IL364113383OtherEIN
IL364113383OtherEIN