MEDICARE: NICOLE SHEETS 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
1	1041C0700X	Clinical Social Worker	34004909A	IN

General Provider Information

NPI Number	:	1962517623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE SHEETS MSW, LCSW

Provider Business Mailing Address
First Line	:	1033 WILLOW DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-5242
Country	:	US
Telephone Number	:	317-507-4316
Fax Number	:	317-849-8342

Provider Business Practice Location Address
First Line	:	6930 E 71ST ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-4262
Country	:	US
Telephone Number	:	317-841-1511
Fax Number	:	317-849-8342

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/08/2007

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