Individual
DR. SUMMER L IBARRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
5230 E STOP 11 RD STE 350, INDIANAPOLIS, IN 46237-6402
(317) 783-8383
Mailing address
10293 N MERIDIAN ST, STE 210, CARMEL, IN 46290-1079
(317) 581-2292
(317) 581-2285
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
20042730A
IN
103TR0400X
Rehabilitation Psychologist
Primary
20042730A
IN
103TR0400X
Rehabilitation Psychologist
99058381A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000863597
ANTHEM
IN
Enumeration date
08/01/2013
Last updated
11/09/2020
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