Provider Demographics
NPI:1164473849
Name:BOEHME, LYNDA CAROLE (LCSW)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:CAROLE
Last Name:BOEHME
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8710 N MERIDIAN ST
Mailing Address - Street 2:STE 100 A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5389
Mailing Address - Country:US
Mailing Address - Phone:317-409-5887
Mailing Address - Fax:317-735-9638
Practice Address - Street 1:8710 N MERIDIAN ST
Practice Address - Street 2:STE 100 A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5389
Practice Address - Country:US
Practice Address - Phone:317-409-5887
Practice Address - Fax:317-735-9638
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003831A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
225138000OtherMAGELLAN
IN000000222230OtherANTHEM BCBS