Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | ||
N | 103TC0700X | Clinical Psychologist | ||
Y | 103G00000X | Clinical Psychologist | 20042428A | IN |
Y | 103TC0700X | Clinical Psychologist | 20042428A | IN |
N | 103TH0100X | Health Service | 20042428A | IN |
NPI | 1245550748 |
---|---|
Provider Name | Andrea R Moreau-O'donnell |
First Address | Indianapolis, IN 46290-1079 |
Second Address | Indianapolis, IN 46290-1079 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2010 |
Last Update Date | 20/03/2019 |