MEDICARE: MR. PATRICK J MCWEENY MSSA, LCSW

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	34000782A	IN

General Provider Information

NPI Number	:	1376646679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK J MCWEENY MSSA, LCSW

Provider Business Mailing Address
First Line	:	429 E VERMONT ST
Second Line	:	SUITE # 205
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3690
Country	:	US
Telephone Number	:	317-423-0855
Fax Number	:	317-631-5872

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	:	317-423-0855
Fax Number	:	317-631-5872

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/08/2007

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