Provider Demographics
NPI:1669950432
Name:SMITH, RINDA JO (LSW)
Entity type:Individual
Prefix:
First Name:RINDA
Middle Name:JO
Last Name:SMITH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8690 JAFFA COURT WEST DR APT 16
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5332
Mailing Address - Country:US
Mailing Address - Phone:256-497-4790
Mailing Address - Fax:
Practice Address - Street 1:2160 W 86TH ST STE 201
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1908
Practice Address - Country:US
Practice Address - Phone:317-844-2442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99087182A104100000X
IN33009091A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN33009091AOtherINDIANA PROFESSIONAL LICENSING AGENCY