MEDICARE: VERSINO PSYCHOLOGICAL SERVICES LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1063195626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERSINO PSYCHOLOGICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	5440 E FALL CREEK PARKWAY NORTH DR STE A2
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-1463
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5440 E FALL CREEK PARKWAY NORTH DR STE A2
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-1463
Country	:	US
Telephone Number	:	317-324-8591
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. HANNAH VERSINO
Credential	:	PSY.D., HSPP
Telephone Number	:	317-324-8591

Provider Enumeration Date	:	08/10/2023
Last Update Date	:	08/10/2023

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