Provider Demographics
NPI:1952709867
Name:SCHWARTZKOPF, KATHERINE NICOLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:NICOLE
Last Name:SCHWARTZKOPF
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:NICOLE
Other - Last Name:DANIELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1026
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1026
Mailing Address - Country:US
Mailing Address - Phone:317-777-6435
Mailing Address - Fax:317-777-6644
Practice Address - Street 1:705 RILEY DRIVE
Practice Address - Street 2:ROC 4210
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-944-3774
Practice Address - Fax:317-944-8521
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043356B103TC2200X
IN20043356A103TC2200X
KYPSYPAT00211991390200000X
MD390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300039766Medicaid