=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144255662
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GLORIA M LINVILLE MSW, LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2006
-----------------------------------------------------
Last Update Date | 09/04/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 128 W CARMEL DR
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46032-2526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-624-8144
-----------------------------------------------------
Fax | 317-844-2929
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 463
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46082-0463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-624-8144
-----------------------------------------------------
Fax | 317-844-2929
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 34000773A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------