Healthcare Provider Details

I. General information

NPI: 1376103143
Provider Name (Legal Business Name): CHRISTY ANN HARPOLD MSW. LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTY ANN BRUCK

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E BOYD AVE STE 250
GREENFIELD IN
46140-2845
US

IV. Provider business mailing address

205 ALLEN LN
GREENFIELD IN
46140-1306
US

V. Phone/Fax

Practice location:
  • Phone: 317-467-4500
  • Fax:
Mailing address:
  • Phone: 317-498-2408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33004998A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: