MEDICARE: MRS. DIANNE TERESA COSEY MSW, LSW

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	34009656A	IN
2	104100000X	Social Worker	33005601A	IN

General Provider Information

NPI Number	:	1487884581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANNE TERESA COSEY MSW, LSW

Provider Business Mailing Address
First Line	:	PO BOX 746720
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6720
Country	:	US
Telephone Number	:	312-733-9730
Fax Number	:

Provider Business Practice Location Address
First Line	:	2240 E 53RD ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-3479
Country	:	US
Telephone Number	:	317-933-7047
Fax Number	:

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

Provider Enumeration Date	:	07/23/2009
Last Update Date	:	06/06/2023

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