Healthcare Provider Details

I. General information

NPI: 1750626115
Provider Name (Legal Business Name): ELIZABETH RAE PITCHER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 07/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11956 FISHERS CROSSING DR
FISHERS IN
46038-2702
US

IV. Provider business mailing address

11956 FISHERS CROSSING DR
FISHERS IN
46038-2702
US

V. Phone/Fax

Practice location:
  • Phone: 317-842-5555
  • Fax: 317-842-5556
Mailing address:
  • Phone: 317-842-5555
  • Fax: 317-842-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33006393A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34007232A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: