Healthcare Provider Details

I. General information

NPI: 1831426105
Provider Name (Legal Business Name): BEVERLY ANN MUSSETTER MSW, ACSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2009
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 W CARMEL DR SUITE 212
CARMEL IN
46032-5877
US

IV. Provider business mailing address

615 W CARMEL DR STE 120
CARMEL IN
46032-5501
US

V. Phone/Fax

Practice location:
  • Phone: 317-569-5433
  • Fax: 317-569-1767
Mailing address:
  • Phone: 317-569-5433
  • Fax: 317-569-1767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34003680A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: