Healthcare Provider Details

I. General information

NPI: 1316216963
Provider Name (Legal Business Name): SUSAN A MICHNAY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2011
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8920 SOUTHPOINTE DR STE E1
INDIANAPOLIS IN
46227-7505
US

IV. Provider business mailing address

898 E MAIN ST
GREENWOOD IN
46143-1407
US

V. Phone/Fax

Practice location:
  • Phone: 317-851-1004
  • Fax: 317-386-7695
Mailing address:
  • Phone: 317-887-1348
  • Fax: 317-885-9063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34004865A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: