Healthcare Provider Details

I. General information

NPI: 1851512578
Provider Name (Legal Business Name): LINA MARIO PULIDO-RAMIREZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17840 CUMBERLAND RD
NOBLESVILLE IN
46060-5409
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 317-574-1254
  • Fax: 317-674-0060
Mailing address:
  • Phone: 317-587-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34006696A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: