Healthcare Provider Details

I. General information

NPI: 1477600237
Provider Name (Legal Business Name): DEIDRA JOEL LOYD MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 N COLLEGE AVE STE 101
INDIANAPOLIS IN
46205-2734
US

IV. Provider business mailing address

4737 N LONGWORTH AVE
INDIANAPOLIS IN
46226-2827
US

V. Phone/Fax

Practice location:
  • Phone: 317-931-8018
  • Fax: 317-931-0943
Mailing address:
  • Phone: 317-513-9404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: