Provider Demographics
NPI:1245550748
Name:MOREAU-O'DONNELL, ANDREA R (PSYD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:R
Last Name:MOREAU-O'DONNELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:R
Other - Last Name:MOREAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:9302 N MERIDIAN ST STE 337
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1843
Mailing Address - Country:US
Mailing Address - Phone:317-981-2971
Mailing Address - Fax:317-593-5678
Practice Address - Street 1:9302 N MERIDIAN ST STE 337
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1843
Practice Address - Country:US
Practice Address - Phone:317-981-2971
Practice Address - Fax:317-593-5678
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X
IN20042428A103TH0100X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service