Healthcare Provider Details

I. General information

NPI: 1568632826
Provider Name (Legal Business Name): MARJORIE D CLINE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 05/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 S STATE ROAD 135
GREENWOOD IN
46143-9607
US

IV. Provider business mailing address

6626 E 75TH STREET SUITE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-535-4075
  • Fax: 317-535-4076
Mailing address:
  • Phone: 317-621-7561
  • Fax: 317-355-6096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34001363A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: