Provider Demographics
NPI:1770636292
Name:CHAVKIN, PAULA RUTH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:RUTH
Last Name:CHAVKIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6745 GRAY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-3262
Mailing Address - Country:US
Mailing Address - Phone:317-780-1681
Mailing Address - Fax:317-780-1781
Practice Address - Street 1:6745 GRAY RD
Practice Address - Street 2:SUITE B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-3262
Practice Address - Country:US
Practice Address - Phone:317-780-1681
Practice Address - Fax:317-780-1781
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001210A1041C0700X
IN35000585A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN273140Medicare ID - Type Unspecified