Provider Demographics
NPI:1619913837
Name:WOOCK, STEPHEN R (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:WOOCK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-962-3834
Mailing Address - Fax:
Practice Address - Street 1:6820 PARKDALE PL
Practice Address - Street 2:STE 115
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-4699
Practice Address - Country:US
Practice Address - Phone:317-329-7300
Practice Address - Fax:317-329-7325
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN390007261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN676310IMedicare PIN
INM400014571Medicare PIN
INS48472Medicare UPIN