Healthcare Provider Details

I. General information

NPI: 1073513461
Provider Name (Legal Business Name): NEAL WILLIAMS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 06/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 RANSDELL RD
LEBANON IN
46052-2349
US

IV. Provider business mailing address

9615 E 148TH ST SUITE 1
NOBLESVILLE IN
46060-4360
US

V. Phone/Fax

Practice location:
  • Phone: 765-482-7100
  • Fax: 317-674-0059
Mailing address:
  • Phone: 317-587-0500
  • Fax: 317-674-0059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34003509A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: