Basic Information
| Provider Information | |||||||||
| NPI: | 1265914410 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NORRIS | ||||||||
| FirstName: | MADISON | ||||||||
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| Credential: | BSW, MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6298 CROOKED CREEK WEST DR | ||||||||
| Address2: | |||||||||
| City: | MARTINSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461518399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176506690 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5638 PROFESSIONAL CIR | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462415042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8887141927 | ||||||||
| FaxNumber: | 3177459565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2018 | ||||||||
| LastUpdateDate: | 01/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 99088481A | IN | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.