Healthcare Provider Details

I. General information

NPI: 1902878200
Provider Name (Legal Business Name): DAVID HARPENAU LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 N MARR RD
COLUMBUS IN
47201-6660
US

IV. Provider business mailing address

720 N MARR RD
COLUMBUS IN
47201-6660
US

V. Phone/Fax

Practice location:
  • Phone: 812-314-3400
  • Fax: 812-378-8367
Mailing address:
  • Phone: 812-314-3400
  • Fax: 812-378-8367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34001483A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier000000209115
Identifier TypeOTHER
Identifier StateIN
Identifier IssuerANTHEM PIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: