Provider Demographics
NPI:1619259744
Name:SCHABEL, JEROMEY SCOTT (BS)
Entity Type:Individual
Prefix:
First Name:JEROMEY
Middle Name:SCOTT
Last Name:SCHABEL
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 CEMBRA DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7694
Mailing Address - Country:US
Mailing Address - Phone:317-294-5152
Mailing Address - Fax:
Practice Address - Street 1:701 CEMBRA DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-7694
Practice Address - Country:US
Practice Address - Phone:317-294-5152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN362-CAMedicaid