Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | 33007852A | IN |
Y | 1041C0700X | Clinical Social Worker | 34008329A | IN |
NPI | 1003335092 |
---|---|
Provider Name | Lindsay Bennett |
First Address | Indianapolis, IN 46236-9791 |
Second Address | Indianapolis, IN 46236-9791 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2017 |
Last Update Date | 09/10/2019 |