Provider Demographics
NPI:1255634457
Name:TALIFARRO, SALIHAH NADAE (LCSW)
Entity type:Individual
Prefix:
First Name:SALIHAH
Middle Name:NADAE
Last Name:TALIFARRO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SALIHAH
Other - Middle Name:NADAE
Other - Last Name:COPEDGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:2040 N SHADELAND
Mailing Address - Street 2:STE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-1734
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6626 E 75TH STREET
Practice Address - Street 2:STE 500
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-2890
Practice Address - Country:US
Practice Address - Phone:317-621-7561
Practice Address - Fax:317-355-6096
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801092201104100000X
IN34007045A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker