Provider Demographics
NPI:1346203098
Name:MCDOWELL, DIANE EVELYN (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:EVELYN
Last Name:MCDOWELL
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 1:21703 SIX POINTS RD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:IN
Mailing Address - Zip Code:46069-9705
Mailing Address - Country:US
Mailing Address - Phone:317-264-9398
Mailing Address - Fax:
Practice Address - Street 1:7165 CLEARVISTA PARKWAY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-4621
Practice Address - Country:US
Practice Address - Phone:317-621-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004641A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN265570015Medicare PIN
IN165490070Medicare PIN