Provider Demographics
NPI:1376646679
Name:MCWEENY, PATRICK J (MSSA, LCSW)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:J
Last Name:MCWEENY
Suffix:
Gender:M
Credentials:MSSA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 E VERMONT ST
Mailing Address - Street 2:SUITE # 205
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3690
Mailing Address - Country:US
Mailing Address - Phone:317-423-0855
Mailing Address - Fax:317-631-5872
Practice Address - Street 1:429 E VERMONT ST
Practice Address - Street 2:SUITE # 205
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3690
Practice Address - Country:US
Practice Address - Phone:317-423-0855
Practice Address - Fax:317-631-5872
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000782A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN170550Medicare ID - Type Unspecified