MEDICARE: STEPHANIE SUZANNE NADER 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	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker	34005863A	IN

General Provider Information

NPI Number	:	1316971963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE SUZANNE NADER LCSW

Provider Business Mailing Address
First Line	:	6626 E 75TH ST
Second Line	:	SUITE 500
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2805
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10122 E. 10TH STREET
Second Line	:	SUITE 100
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46229-2697
Country	:	US
Telephone Number	:	317-355-5717
Fax Number	:	317-355-3760

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/21/2015

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