Individual provider Active NPI

Martha E Prieto-Melloy, LCSW

  • Clinical Social Worker
  • Indianapolis, IN
National Provider Identifier
1629158076
Registry record updated Nov 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34005552A Issued in IN
Practice address
1431 N Delaware St
Indianapolis, IN 46202-2416
Phone
(317) 536-7100
Fax
(317) 536-7101
NPI assigned
Oct 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 34005552A IN Primary

Addresses

Primary practice location

1431 N Delaware St
Indianapolis, IN 46202-2416

Mailing address

1431 N Delaware St
Indianapolis, IN 46202-2416
Phone (317) 536-7100

Other identifiers 1

IdentifierTypeStateIssuer
100270530AMedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
34005552AINMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447891200000",
    "number": "1629158076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1431 N DELAWARE ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462022416",
            "telephone_number": "317-536-7100",
            "fax_number": "317-536-7101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1431 N DELAWARE ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462022416",
            "telephone_number": "317-536-7100",
            "fax_number": "317-536-7101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIETO-MELLOY",
        "first_name": "MARTHA",
        "middle_name": "E",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-17",
        "last_updated": "2015-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34005552A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100270530A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.