1699868513 NPI number — MRS. JENNIFER ELIZABETH JOSEPH MSW, LCSW

Table of content: DR. SORA RADAIN BDS (NPI 1447790548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699868513 NPI number — MRS. JENNIFER ELIZABETH JOSEPH MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOSEPH
Provider First Name:
JENNIFER
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699868513
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11929 SAND DOLLAR CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46256-9683
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-518-0796
Provider Business Mailing Address Fax Number:
844-774-0513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
52 S 9TH ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
NOBLESVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46060-2601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-498-7926
Provider Business Practice Location Address Fax Number:
844-774-0513
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  34005621A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000594137 . This is a "ANTHEM BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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