Individual
MR. MARK WARREN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
819 E 64TH ST, INDIANAPOLIS, IN 46220-1671
(317) 251-5504
(317) 251-1691
Mailing address
819 E 64TH ST, INDIANAPOLIS, IN 46220-1671
(317) 251-5504
(317) 251-1691
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34000746A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000345326
ANTHEM ID NUMBER
IN
Enumeration date
01/03/2007
Last updated
07/08/2007
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