MEDICARE: MR. JOSHUA LAWRENCE SUMNER 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	104100000X	Social Worker	33006095A	IN
2	1041C0700X	Clinical Social Worker	34006778A	IN

General Provider Information

NPI Number	:	1730433244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSHUA LAWRENCE SUMNER LCSW

Provider Business Mailing Address
First Line	:	1481 W 10TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-2803
Country	:	US
Telephone Number	:	317-988-9604
Fax Number	:	317-988-5359

Provider Business Practice Location Address
First Line	:	550 UNIVERSITY BLVD RM 4601
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202
Country	:	US
Telephone Number	:	317-948-8301
Fax Number	:	317-944-4010

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

Provider Enumeration Date	:	11/06/2012
Last Update Date	:	08/02/2018

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