Provider Demographics
NPI:1336293166
Name:THORNBURG, BARBARA LOUISE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:LOUISE
Last Name:THORNBURG
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 1:9507 E 86TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-9705
Mailing Address - Country:US
Mailing Address - Phone:317-581-1433
Mailing Address - Fax:317-581-1471
Practice Address - Street 1:9135 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1878
Practice Address - Country:US
Practice Address - Phone:317-581-1433
Practice Address - Fax:317-581-1471
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000974-A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN265560Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER