Individual
MELISSA INTERESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
5162 E STOP 11 RD, SUITE 1, INDIANAPOLIS, IN 46237-8617
(617) 784-7762
Mailing address
211 E BEVERLY DR, INDIANAPOLIS, IN 46205-1029
(617) 784-7762
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34005769A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200372510
—
IN
Enumeration date
03/17/2010
Last updated
03/17/2010
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