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NPI Code Detail

MEDICARE: SENIOR GUIDANCE, A PROFESSIONAL SERVICES CORPORATION

MEDICARE: SENIOR GUIDANCE, A PROFESSIONAL SERVICES CORPORATION
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 Worker34001501AIN

General Provider Information

NPI Number : 1962405472
Entity Type Code : Organization
Provider Name (Legal Business Name) : SENIOR GUIDANCE, A PROFESSIONAL SERVICES CORPORATION
Provider Business Mailing Address
First Line : 2831 MOUNT TABOR RD
Second Line :
City : NEW ALBANY
State : IN
Zip : 47150-2075
Country : US
Telephone Number : 812-949-2253
Fax Number : 812-949-1335
Provider Business Practice Location Address
First Line : 2580 CHARLESTOWN RD
Second Line :
City : NEW ALBANY
State : IN
Zip : 47150-2555
Country : US
Telephone Number : 812-949-2253
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MS. SUSAN KAY COCHRAN
Credential : LCSW
Telephone Number : 812-949-2253
Provider Enumeration Date : 05/30/2005
Last Update Date : 03/17/2008

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