Provider Demographics
NPI:1548258791
Name:LOTFALIAN, JANIS ELIZABETH (LCSW LMFT)
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:ELIZABETH
Last Name:LOTFALIAN
Suffix:
Gender:F
Credentials:LCSW LMFT
Other - Prefix:
Other - First Name:JANIS
Other - Middle Name:ELIZABETH
Other - Last Name:SHUBITOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:6268 HOOVER RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-4740
Mailing Address - Country:US
Mailing Address - Phone:812-477-2350
Mailing Address - Fax:812-477-2378
Practice Address - Street 1:6268 HOOVER RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-4740
Practice Address - Country:US
Practice Address - Phone:812-589-1545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000231A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN017128000OtherMAGELLAN
IN000000270497OtherBC
S42233Medicare UPIN