Provider Demographics
NPI:1790197291
Name:VAIL, MARIA JOANN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:JOANN
Last Name:VAIL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 CONRAD HARCOURT WAY
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46173-1165
Mailing Address - Country:US
Mailing Address - Phone:765-561-0840
Mailing Address - Fax:
Practice Address - Street 1:509 CONRAD HARCOURT WAY
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IN
Practice Address - Zip Code:46173-1165
Practice Address - Country:US
Practice Address - Phone:765-561-0840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006705A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical