Provider Demographics
NPI:1811058811
Name:RADER, ALLEN MARCELLUS (LCSW)
Entity type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:MARCELLUS
Last Name:RADER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5455 W 86TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-1504
Mailing Address - Country:US
Mailing Address - Phone:317-820-3600
Mailing Address - Fax:317-663-0914
Practice Address - Street 1:5455 W 86TH ST STE 110
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1504
Practice Address - Country:US
Practice Address - Phone:317-820-3600
Practice Address - Fax:317-663-0914
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003862A101YM0800X, 104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
7771028OtherAETNA HEALTHCARE
IN7771028OtherAETNA
158107OtherVALUE OPTIONS
000000193667OtherANTHEM
2111654OtherCIGNA HEALTHCARE
247448OtherMANAGED HEALTH NETWORK