MEDICARE: KAMRI DOMANIQUE MCDANIEL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1063176642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMRI DOMANIQUE MCDANIEL LCSW

Provider Business Mailing Address
First Line	:	3250A W 86TH ST # 1104
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-3605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3250A W 86TH ST # 1104
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-3605
Country	:	US
Telephone Number	:	317-458-2667
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2021
Last Update Date	:	02/23/2026

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