Provider Demographics
NPI:1013968676
Name:BERDAY, JENNIFER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:BERDAY
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 1:1030 W 72ND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-4037
Mailing Address - Country:US
Mailing Address - Phone:317-253-5661
Mailing Address - Fax:
Practice Address - Street 1:7001 HOOVER RD
Practice Address - Street 2:HOOVERWOOD NURSING HOME
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-4037
Practice Address - Country:US
Practice Address - Phone:317-251-2261
Practice Address - Fax:317-257-8423
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003324A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN215610HMedicare PIN