MEDICARE: MRS. KRISTINE S. MATEL L.C.S.W

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	34003108A	IN

General Provider Information

NPI Number	:	1356587612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTINE S. MATEL L.C.S.W

Provider Business Mailing Address
First Line	:	9231 N TACOMA AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-1331
Country	:	US
Telephone Number	:	317-580-1642
Fax Number	:

Provider Business Practice Location Address
First Line	:	9231 N TACOMA AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-1331
Country	:	US
Telephone Number	:	317-580-1642
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2008
Last Update Date	:	12/16/2008

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