Provider Demographics
NPI:1528012481
Name:POWELL, RONALD ALAN (MSW LSW)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:ALAN
Last Name:POWELL
Suffix:
Gender:M
Credentials:MSW LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-5707
Mailing Address - Country:US
Mailing Address - Phone:765-935-7284
Mailing Address - Fax:765-935-5002
Practice Address - Street 1:1901 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-5707
Practice Address - Country:US
Practice Address - Phone:765-935-7284
Practice Address - Fax:765-935-5002
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200537320AMedicaid