Provider Demographics
NPI:1598764581
Name:MINOR, NORMAN EARL JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:EARL
Last Name:MINOR
Suffix:JR
Gender:M
Credentials:LCSW
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Mailing Address - Street 1:550 N. UNIVERSITY BLVD
Mailing Address - Street 2:ROOM 2155
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5149
Mailing Address - Country:US
Mailing Address - Phone:317-944-2344
Mailing Address - Fax:317-948-9265
Practice Address - Street 1:550 N. UNIVERSITY BLVD
Practice Address - Street 2:ROOM 2155
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:317-944-2344
Practice Address - Fax:317-948-9265
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004298A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100073590Medicaid
IN317190KKMedicare Oscar/Certification