Provider Demographics
NPI:1649364985
Name:WESTCOTT, POLLY JANE (PSYD)
Entity type:Individual
Prefix:DR
First Name:POLLY
Middle Name:JANE
Last Name:WESTCOTT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:POLLY
Other - Middle Name:HUGHES
Other - Last Name:SHEPARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:703 PRO-MED LN
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5317
Mailing Address - Country:US
Mailing Address - Phone:317-843-9922
Mailing Address - Fax:317-581-3918
Practice Address - Street 1:703 PRO-MED LN
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5317
Practice Address - Country:US
Practice Address - Phone:317-843-9922
Practice Address - Fax:317-581-3918
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042062A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN227830DMedicare PIN