MEDICARE: DIOSA MENTAL HEALTH LLC

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

General Provider Information

NPI Number	:	1942178397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIOSA MENTAL HEALTH LLC

Provider Business Mailing Address
First Line	:	1015 E MAIN ST STE 200
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-5842
Country	:	US
Telephone Number	:	812-605-5201
Fax Number	:	812-605-5201

Provider Business Practice Location Address
First Line	:	1015 E MAIN ST STE 200
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-5842
Country	:	US
Telephone Number	:	812-605-5201
Fax Number	:	812-605-5201

Authorized Official
Title or Position	:	OWNER
Name	:	ANNA DOMIRAY
Credential	:	LCSW
Telephone Number	:	812-605-5201

Provider Enumeration Date	:	10/27/2025
Last Update Date	:	03/07/2026

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Directions to “DIOSA MENTAL HEALTH LLC ” Practice Location

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