Provider Demographics
NPI:1710059779
Name:LOWE BURRY, STEPHANIE DIANE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:DIANE
Last Name:LOWE BURRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:DIANE
Other - Last Name:LOWE SAGEBIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5708 WINTHROP AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2630
Mailing Address - Country:US
Mailing Address - Phone:173-439-7618
Mailing Address - Fax:
Practice Address - Street 1:8935 N MERIDIAN ST STE 225
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5384
Practice Address - Country:US
Practice Address - Phone:317-439-7618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005082A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201178980AMedicaid
IN201163980Medicaid
ININ1231OtherMEDICARE GROUP
ININ1231003Medicare PIN