Provider Demographics
NPI:1316971963
Name:NADER, STEPHANIE SUZANNE (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SUZANNE
Last Name:NADER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:SUZANNE
Other - Last Name:CURRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10122 E. 10TH STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-2697
Practice Address - Country:US
Practice Address - Phone:317-355-5717
Practice Address - Fax:317-355-3760
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
IN34005863A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400051233Medicare PIN
INM400031743Medicare PIN
INM400071206Medicare PIN
INM400031750Medicare PIN