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NPI Code Detail

MEDICARE: REBECCA DIANE ANDERSON MSW, LCSW

MEDICARE: REBECCA DIANE ANDERSON MSW, 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
11041C0700XClinical Social Worker34008061AIN

General Provider Information

NPI Number : 1396374518
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA DIANE ANDERSON MSW, LCSW
Provider Business Mailing Address
First Line : 210 S EASTERN AVE
Second Line :
City : BATESVILLE
State : IN
Zip : 47006-1427
Country : US
Telephone Number : 812-431-7735
Fax Number :
Provider Business Practice Location Address
First Line : 7941 CASTLEWAY DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46250-1953
Country : US
Telephone Number : 317-995-2359
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2020
Last Update Date : 04/08/2020

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