MEDICARE: MODERN DAY THERAPY, 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	104100000X	Social Worker	33006192A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457779092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODERN DAY THERAPY, LLC

Provider Business Mailing Address
First Line	:	3675 WASHINGTON BLVD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-3533
Country	:	US
Telephone Number	:	317-908-6063
Fax Number	:

Provider Business Practice Location Address
First Line	:	3675 WASHINGTON BLVD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-3533
Country	:	US
Telephone Number	:	317-908-6063
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR/FOUNDER
Name	:	ALICIA COOLEY
Credential	:	MSW, LSW
Telephone Number	:	317-908-6063

Provider Enumeration Date	:	04/01/2014
Last Update Date	:	06/18/2014

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Directions to “MODERN DAY THERAPY, LLC ” Practice Location

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