Provider Demographics
NPI:1730393505
Name:MARSH, CLINTON VERNON (MSW,LSW)
Entity type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:VERNON
Last Name:MARSH
Suffix:
Gender:M
Credentials:MSW,LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11213 BAYRIDGE CIR E
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-8731
Mailing Address - Country:US
Mailing Address - Phone:317-826-0606
Mailing Address - Fax:
Practice Address - Street 1:125 AIRPORT PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1441
Practice Address - Country:US
Practice Address - Phone:317-883-1280
Practice Address - Fax:317-883-1281
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33004666A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1041C0700XOtherCLINICAL SOCIAL WORKER