Provider Demographics
NPI:1528109345
Name:RADO-WILFONG, DOROTHY (LCSW, LMFT, ACSW)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:RADO-WILFONG
Suffix:
Gender:F
Credentials:LCSW, LMFT, ACSW
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:
Other - Last Name:RADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, LMFT, ACSW
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:STE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:317-621-7561
Mailing Address - Fax:317-355-6096
Practice Address - Street 1:7 E HENDRICKS ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-2124
Practice Address - Country:US
Practice Address - Phone:317-392-2564
Practice Address - Fax:317-392-9545
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002288A1041C0700X
IN35001252A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN216020Medicare ID - Type Unspecified