Individual
MCKENZIE CARREL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
6655 E US HIGHWAY 36, AVON, IN 46123-8923
(317) 272-3330
(317) 272-0807
Mailing address
515 BAYOU ST, VINCENNES, IN 47591-1034
(812) 886-6800
(812) 886-6809
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34006761A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100270140
—
IN
01
—
444530
MEDICARE
IN
Enumeration date
12/08/2010
Last updated
06/02/2014
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