Healthcare Provider Details

I. General information

NPI: 1396742441
Provider Name (Legal Business Name): BETH LOUISE FINEBERG PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 WELLINGTON RD
INDIANAPOLIS IN
46260-4620
US

IV. Provider business mailing address

2020 W 86TH ST SUITE 301
INDIANAPOLIS IN
46260-1969
US

V. Phone/Fax

Practice location:
  • Phone: 317-872-4158
  • Fax:
Mailing address:
  • Phone: 317-872-4158
  • Fax: 317-872-4612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0441
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20010207A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: