Provider Demographics
NPI:1013041870
Name:GANOTE, DONNA J (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:J
Last Name:GANOTE
Suffix:
Gender:F
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 1:200 MEDICAL DRIVE
Mailing Address - Street 2:#C2B
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2985
Mailing Address - Country:US
Mailing Address - Phone:317-848-5600
Mailing Address - Fax:317-848-5573
Practice Address - Street 1:200 MEDICAL DRIVE
Practice Address - Street 2:#C2B
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2985
Practice Address - Country:US
Practice Address - Phone:317-848-5600
Practice Address - Fax:317-848-5573
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003268A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
193020Medicare ID - Type Unspecified