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NPI Code Detail

MEDICARE: TRILLIUM ABYSS MSW, LCSW

MEDICARE: TRILLIUM ABYSS 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 Worker33011782AIN

General Provider Information

NPI Number : 1760249890
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRILLIUM ABYSS MSW, LCSW
Provider Business Mailing Address
First Line : 2405 IROQUOIS TRL
Second Line :
City : LAFAYETTE
State : IN
Zip : 47909-2724
Country : US
Telephone Number : 317-300-6824
Fax Number :
Provider Business Practice Location Address
First Line : 429 E VERMONT ST STE 7
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-3688
Country : US
Telephone Number : 317-300-6824
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2024
Last Update Date : 03/10/2026

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