Healthcare Provider Details

I. General information

NPI: 1396163259
Provider Name (Legal Business Name): ROBIN JOYCE PANNELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 E COUNTY LINE RD STE C1
INDIANAPOLIS IN
46227-2998
US

IV. Provider business mailing address

1750 SANDHILL RD
INDIANAPOLIS IN
46217-4655
US

V. Phone/Fax

Practice location:
  • Phone: 317-497-6290
  • Fax:
Mailing address:
  • Phone: 317-370-2204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34004535A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: