Provider Demographics
NPI:1467226126
Name:GREEN-CARNEY, TAHJA
Entity Type:Individual
Prefix:
First Name:TAHJA
Middle Name:
Last Name:GREEN-CARNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9130 OTIS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46216-2032
Mailing Address - Country:US
Mailing Address - Phone:317-992-2910
Mailing Address - Fax:317-981-1512
Practice Address - Street 1:9130 OTIS AVE STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46216-2032
Practice Address - Country:US
Practice Address - Phone:317-992-2910
Practice Address - Fax:317-981-1512
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33011562A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker