Provider Demographics
NPI:1669853073
Name:WEISEL, MARY BETH (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:BETH
Last Name:WEISEL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 ESKENAZI AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5166
Mailing Address - Country:US
Mailing Address - Phone:317-880-6030
Mailing Address - Fax:
Practice Address - Street 1:720 ESKENAZI AVE FL 2
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5189
Practice Address - Country:US
Practice Address - Phone:317-880-7000
Practice Address - Fax:317-880-0526
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007266A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical