Healthcare Provider Details

I. General information

NPI: 1972904555
Provider Name (Legal Business Name): INDIA D WARFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S EDWIN C MOSES BLVD 4TH FLOOR, NW BLDG
DAYTON OH
45417-3424
US

IV. Provider business mailing address

31 S MAIN ST STE 240
DAYTON OH
45402-2070
US

V. Phone/Fax

Practice location:
  • Phone: 937-734-8333
  • Fax: 937-734-4343
Mailing address:
  • Phone: 937-371-6411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2203914
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: