Provider Demographics
NPI:1144255662
Name:LINVILLE, GLORIA M (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:M
Last Name:LINVILLE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 463
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46082-0463
Mailing Address - Country:US
Mailing Address - Phone:317-624-8144
Mailing Address - Fax:317-844-2929
Practice Address - Street 1:128 W CARMEL DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2526
Practice Address - Country:US
Practice Address - Phone:317-624-8144
Practice Address - Fax:317-844-2929
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000773A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN351859940OtherEIN