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NPI Code Detail

MEDICARE: MARTHA E PRIETO-MELLOY LCSW

MEDICARE: MARTHA E PRIETO-MELLOY 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 Worker34005552AIN

Other Identifiers

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

General Provider Information

NPI Number : 1629158076
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTHA E PRIETO-MELLOY LCSW
Provider Business Mailing Address
First Line : 1431 N DELAWARE ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-2416
Country : US
Telephone Number : 317-536-7100
Fax Number : 317-536-7101
Provider Business Practice Location Address
First Line : 1431 N DELAWARE ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-2416
Country : US
Telephone Number : 317-536-7100
Fax Number : 317-536-7101
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2006
Last Update Date : 11/19/2015

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Directions to “ MARTHA E PRIETO-MELLOY LCSW” Practice Location

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