Provider Demographics
NPI:1720158744
Name:GODFREY-CHOATE, KAREN J (LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:J
Last Name:GODFREY-CHOATE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8320 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-6066
Mailing Address - Country:US
Mailing Address - Phone:317-882-5122
Mailing Address - Fax:317-888-8642
Practice Address - Street 1:9670 E WASHINGTON ST
Practice Address - Street 2:STE 120
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-3038
Practice Address - Country:US
Practice Address - Phone:317-890-5700
Practice Address - Fax:317-890-5717
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33005115A1041C0700X
IN34005834A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN264430337Medicare PIN