MEDICARE: SUSAN JEAN CRANNY 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	34002045A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000176163	OTHER	IN	ANTHEM BCBS

General Provider Information

NPI Number	:	1790775021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN JEAN CRANNY LCSW

Provider Business Mailing Address
First Line	:	6267 LAKELAND LN
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46234-3071
Country	:	US
Telephone Number	:	317-858-0158
Fax Number	:	317-535-8749

Provider Business Practice Location Address
First Line	:	540 TRACY RD
Second Line	:	SUITE C
City	:	NEW WHITELAND
State	:	IN
Zip	:	46184-9699
Country	:	US
Telephone Number	:	317-535-0513
Fax Number	:	317-535-8749

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	07/08/2007

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Directions to “ SUSAN JEAN CRANNY LCSW” Practice Location

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