Provider Demographics
NPI:1477681948
Name:WADDELL, MARIA T (PHD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:T
Last Name:WADDELL
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 1:10291 N MERIDIAN ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1076
Mailing Address - Country:US
Mailing Address - Phone:317-833-0553
Mailing Address - Fax:317-853-1314
Practice Address - Street 1:10291 N MERIDIAN ST
Practice Address - Street 2:SUITE 160
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46290-1076
Practice Address - Country:US
Practice Address - Phone:317-833-0553
Practice Address - Fax:317-853-1314
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040300A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
202844714OtherTAX ID NUMBER
202844714OtherTAX ID NUMBER