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General NPI Number Information
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NPI Number | 1417147752
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Entity Type | Individual
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Provider Name | JENNIFER DEFELICE LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/01/2007
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 1500 NORTH RITTER AVENUE
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-3027
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Country | US
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Telephone | 317-355-2560
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Fax |
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Provider Business Mailing Address
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Address Line | 7721 N TAYLOR TRL
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City | MOORESVILLE
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State | IN
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Zip | 46158-6287
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Country | US
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Telephone | 317-727-7592
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 34005981A
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License Number State | IN
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