Provider Demographics
NPI:1316694052
Name:MESSINA-GRAHAM, REBECCA (MSW, LSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MESSINA-GRAHAM
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 N EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-2930
Mailing Address - Country:US
Mailing Address - Phone:317-991-0032
Mailing Address - Fax:
Practice Address - Street 1:5660 CAITO DR STE 126
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-1368
Practice Address - Country:US
Practice Address - Phone:317-207-6095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33004890A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker