Healthcare Provider Details

I. General information

NPI: 1609412600
Provider Name (Legal Business Name): SARA HUTSON MSW, LCSW, CSAYC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 S STATE AVE STE 357
INDIANAPOLIS IN
46201-3896
US

IV. Provider business mailing address

137 KANSAS ST
INDIANAPOLIS IN
46225-1521
US

V. Phone/Fax

Practice location:
  • Phone: 317-507-7068
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34008706A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: