Healthcare Provider Details

I. General information

NPI: 1972799971
Provider Name (Legal Business Name): STACY D VEACH MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8820 S MERIDIAN ST SUITE 225
INDIANAPOLIS IN
46217-6056
US

IV. Provider business mailing address

250 N SHADELAND AVE 2ND FL
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-865-6922
  • Fax: 317-865-6930
Mailing address:
  • Phone: 317-962-4792
  • Fax: 317-962-8646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34004112A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: