MEDICARE: ROBERT C KINNEAR 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	101YM0800X	Mental Health Counselor	39001098A	IN
2	1041C0700X	Clinical Social Worker	34001642A	IN
3	106H00000X	Marriage & Family Therapist	35000874A	IN
4	163W00000X	Registered Nurse	28169390A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881638815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT C KINNEAR LCSW

Provider Business Mailing Address
First Line	:	9510 PROSPECT ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239-9639
Country	:	US
Telephone Number	:	317-898-7446
Fax Number	:

Provider Business Practice Location Address
First Line	:	9510 PROSPECT ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239-9639
Country	:	US
Telephone Number	:	317-898-7446
Fax Number	:

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	04/05/2016

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