Provider Demographics
NPI:1497065569
Name:MCCLUSKEY, IRENE ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:ANN
Last Name:MCCLUSKEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:ANN
Other - Last Name:MCCLUSKEY WORLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1700 N ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1316
Mailing Address - Country:US
Mailing Address - Phone:317-554-5789
Mailing Address - Fax:317-931-5113
Practice Address - Street 1:1700 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1316
Practice Address - Country:US
Practice Address - Phone:317-554-5789
Practice Address - Fax:317-931-5113
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006076A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000924835OtherANTHEM
IN000000924835OtherANTHEM