Provider Demographics
NPI:1205888146
Name:FAY, SUSAN ANNE (RN MSN MSW LCSW CPNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANNE
Last Name:FAY
Suffix:
Gender:F
Credentials:RN MSN MSW LCSW CPNP
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8710 N MERIDIAN ST
Mailing Address - Street 2:STE 100C
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5389
Mailing Address - Country:US
Mailing Address - Phone:317-663-7302
Mailing Address - Fax:317-735-9638
Practice Address - Street 1:8710 N MERIDIAN ST
Practice Address - Street 2:STE 100C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5389
Practice Address - Country:US
Practice Address - Phone:317-663-7302
Practice Address - Fax:317-735-9638
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003872104100000X
IN71001242A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000212827OtherBCBS
000000282033OtherBCBS