MEDICARE: THE PSYCHOTHERAPY OFFICES OF DAVID KEARBY LCSW, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	34006810A	IN

General Provider Information

NPI Number	:	1073910360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PSYCHOTHERAPY OFFICES OF DAVID KEARBY LCSW, LLC

Provider Business Mailing Address
First Line	:	6413 KENTSTONE DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-4864
Country	:	US
Telephone Number	:	317-215-0548
Fax Number	:

Provider Business Practice Location Address
First Line	:	429 E VERMONT ST
Second Line	:	SUITE 205
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3690
Country	:	US
Telephone Number	:	317-215-0548
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DAVID ALAN KEARBY II
Credential	:	LCSW
Telephone Number	:	317-215-0548

Provider Enumeration Date	:	12/02/2014
Last Update Date	:	12/02/2014

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