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NPI Code Detail

MEDICARE: LISA MASTRIANNA LCSW

MEDICARE: LISA MASTRIANNA 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
11041C0700XClinical Social Worker34005700AIN

General Provider Information

NPI Number : 1649408618
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA MASTRIANNA LCSW
Provider Business Mailing Address
First Line : 5137 KINGSLEY DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46205-1335
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 618 N HIGH SCHOOL RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46214-3684
Country : US
Telephone Number : 317-381-0355
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2009
Last Update Date : 06/29/2009

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Directions to “ LISA MASTRIANNA LCSW” Practice Location

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