Provider Demographics
NPI:1467410118
Name:CUMBERLANDER ZOLICOFFER, NATALIE DENISE (PHD, HSPP)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:DENISE
Last Name:CUMBERLANDER ZOLICOFFER
Suffix:
Gender:F
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 HADLEIGH PASS
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-5902
Mailing Address - Country:US
Mailing Address - Phone:317-225-1381
Mailing Address - Fax:
Practice Address - Street 1:6640 INTECH BLVD
Practice Address - Street 2:STE 195
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-2011
Practice Address - Country:US
Practice Address - Phone:317-295-0608
Practice Address - Fax:317-295-0622
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041781103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01792194OtherRRMEDICARE
IN200384650Medicaid
INP01792194OtherRRMEDICARE
IN210870FMedicare PIN