Healthcare Provider Details

I. General information

NPI: 1205888146
Provider Name (Legal Business Name): SUSAN ANNE FAY RN MSN MSW LCSW CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8710 N MERIDIAN ST STE 100C
INDIANAPOLIS IN
46260-5389
US

IV. Provider business mailing address

8710 N MERIDIAN ST STE 100C
INDIANAPOLIS IN
46260-5389
US

V. Phone/Fax

Practice location:
  • Phone: 317-663-7302
  • Fax: 317-735-9638
Mailing address:
  • Phone: 317-663-7302
  • Fax: 317-735-9638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71001242A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number34003872
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: