Healthcare Provider Details

I. General information

NPI: 1487309027
Provider Name (Legal Business Name): ERIN MRAKOVICH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 COMMERCE DR
CARMEL IN
46032-7636
US

IV. Provider business mailing address

9831 CHESTERTON DR
CARMEL IN
46280-1845
US

V. Phone/Fax

Practice location:
  • Phone: 317-296-8953
  • Fax:
Mailing address:
  • Phone: 317-296-3953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34008833A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: