MEDICARE: DR. HANNAH MARIE VERSINO PSY.D.

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	103TC2200X	Clinical Child & Adolescent Psychologist	20042939A	IN

General Provider Information

NPI Number	:	1659620524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HANNAH MARIE VERSINO PSY.D.

Provider Business Mailing Address
First Line	:	5440 E FALL CREEK PARKWAY NORTH DR STE A2
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-1463
Country	:	US
Telephone Number	:	317-324-8591
Fax Number	:

Provider Business Practice Location Address
First Line	:	5440 E FALL CREEK PARKWAY NORTH DR STE A2
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-1463
Country	:	US
Telephone Number	:	317-324-8591
Fax Number	:

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

Provider Enumeration Date	:	09/06/2012
Last Update Date	:	08/08/2023

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