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NPI Code Detail

MEDICARE: LISA DIANE CARRICO

MEDICARE: LISA DIANE CARRICO
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 Worker34002668AIN

General Provider Information

NPI Number : 1801412895
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA DIANE CARRICO
Provider Business Mailing Address
First Line : 6640 INTECH BLVD STE 195
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46278-2014
Country : US
Telephone Number : 317-295-0608
Fax Number : 317-295-0622
Provider Business Practice Location Address
First Line : 6640 INTECH BLVD STE 195
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46278-2014
Country : US
Telephone Number : 317-295-0608
Fax Number : 317-295-0622
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2020
Last Update Date : 06/25/2020

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Directions to “ LISA DIANE CARRICO ” Practice Location

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