MEDICARE: PATRICIA ANN ANDERSON 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	1481	KY
2	1041C0700X	Clinical Social Worker	34005569A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000384273	OTHER	KY	ANTHEM BC/BS
2	1218723	OTHER	KY	CHA HEALTH

General Provider Information

NPI Number	:	1629154265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA ANN ANDERSON LCSW

Provider Business Mailing Address
First Line	:	1040 SIERRA DR
Second Line	:	SUITE 400
City	:	GREENWOOD
State	:	IN
Zip	:	46143-7240
Country	:	US
Telephone Number	:	317-528-4886
Fax Number	:	317-859-8239

Provider Business Practice Location Address
First Line	:	610 E SOUTHPORT RD
Second Line	:	SUITE 100
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-8590
Country	:	US
Telephone Number	:	317-783-8383
Fax Number	:	317-782-6929

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	04/23/2015

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Directions to “ PATRICIA ANN ANDERSON LCSW” Practice Location

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