MEDICARE: MISS ETHANY OPAL ABBRA MICHAUD 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	1041C0700X	Clinical Social Worker	34009138A	IN

General Provider Information

NPI Number	:	1952917312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ETHANY OPAL ABBRA MICHAUD LCSW

Provider Business Mailing Address
First Line	:	3901 W 86TH ST STE 350
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-5734
Country	:	US
Telephone Number	:	317-676-9593
Fax Number	:	317-271-5038

Provider Business Practice Location Address
First Line	:	3901 W 86TH ST STE 350
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-5734
Country	:	US
Telephone Number	:	317-360-5864
Fax Number	:	317-271-5038

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

Provider Enumeration Date	:	09/21/2020
Last Update Date	:	11/25/2025

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