Provider Demographics
NPI:1588779532
Name:KINNEY, PAMELA D (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:D
Last Name:KINNEY
Suffix:
Gender:
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10903 LANTERN VIEW DR APT 114
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-4216
Mailing Address - Country:US
Mailing Address - Phone:317-260-6012
Mailing Address - Fax:
Practice Address - Street 1:9532 ABERDARE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-3407
Practice Address - Country:US
Practice Address - Phone:317-515-7878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003689A1041C0700X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200459330A GROUP#Medicaid
IN340003689AOther1588779532
000000639623OtherANTHEM PIN# HPN
IN1588779532OtherPAMELA DEE COUNSELING
IN100073590Medicaid