Provider Demographics
NPI:1720620974
Name:CURTIS-LONG, KATHRYN HILARY (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:HILARY
Last Name:CURTIS-LONG
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 1:4626 CITATION CIR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-2168
Mailing Address - Country:US
Mailing Address - Phone:317-313-5960
Mailing Address - Fax:
Practice Address - Street 1:819 E 64TH ST STE 104
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-1677
Practice Address - Country:US
Practice Address - Phone:317-896-0491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34008635A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN35-1862303Medicaid