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NPI Code Detail

MEDICARE: AMBER J BOUSHEHRY MSW, LCSW

MEDICARE:   AMBER J BOUSHEHRY  MSW, 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 Worker34006448AIN

General Provider Information

NPI Number : 1891981544
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMBER J BOUSHEHRY MSW, LCSW
Provider Business Mailing Address
First Line : 1456 BENT TREE PL
Second Line :
City : GREENWOOD
State : IN
Zip : 46143-9083
Country : US
Telephone Number : 317-258-3170
Fax Number :
Provider Business Practice Location Address
First Line : 2345 S LYNHURST DR STE 205
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46241-5100
Country : US
Telephone Number : 317-247-8900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2007
Last Update Date : 02/29/2012

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