Provider Demographics
NPI:1942556352
Name:SEIBERT, SCOTT WADE (MSW, LCSW, CSAYC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:WADE
Last Name:SEIBERT
Suffix:
Gender:M
Credentials:MSW, LCSW, CSAYC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2159 MERIDIAN SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-7282
Mailing Address - Country:US
Mailing Address - Phone:317-498-2121
Mailing Address - Fax:
Practice Address - Street 1:320 N TIBBS AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-4064
Practice Address - Country:US
Practice Address - Phone:317-630-5215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006546A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical