Basic Information
| Provider Information | |||||||||
| NPI: | 1467410118 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CUMBERLANDER ZOLICOFFER | ||||||||
| FirstName: | NATALIE | ||||||||
| MiddleName: | DENISE | ||||||||
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| Credential: | PHD, HSPP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 HADLEIGH PASS | ||||||||
| Address2: | |||||||||
| City: | WESTFIELD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460745902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172251381 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6640 INTECH BLVD | ||||||||
| Address2: | STE 195 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462782011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172950608 | ||||||||
| FaxNumber: | 3172950622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 03/22/2017 | ||||||||
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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 | 103TC0700X | 20041781 | IN | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | P01792194 | 01 | IN | RRMEDICARE | OTHER | 200384650 | 05 | IN | MEDICAID |