Organization
JED MENTAL HEALTH PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANE ELIZABETH DINUNZIO LCSW (PRESIDENT)
(317) 672-6400
Entity
Organization
Contact information
Practice address
192 N STATE ROAD 267, SUITE 300, AVON, IN 46123-9513
(317) 672-6400
(317) 672-6400
Mailing address
192 N STATE ROAD 267, SUITE 300, AVON, IN 46123-9513
(317) 672-6400
(317) 672-6401
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
34005048A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M100060443
MEDICARE PTAN
IN
Enumeration date
11/29/2011
Last updated
01/31/2016
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