Active NPI
Molly J Dagon
- Clinical Social Worker
- Indianapolis, IN
National Provider Identifier
1629662630
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 34008677A
- Practice address
- 4709 Crittenden Ave
Indianapolis, IN 46205-2172 - Phone
- (317) 908-5136
- NPI assigned
- Feb 22, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 34008677A | IN | Primary |
Addresses
Primary practice location
4709 Crittenden Ave
Indianapolis, IN 46205-2172
Mailing address
4709 Crittenden Ave
Indianapolis, IN 46205-2172
Phone (317) 908-5136
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34008677A | IN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1613952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613952000000",
"number": "1629662630",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4709 CRITTENDEN AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462052172",
"telephone_number": "317-908-5136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4709 CRITTENDEN AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462052172",
"telephone_number": "317-908-5136"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAGON",
"first_name": "MOLLY",
"middle_name": "J",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-02-22",
"last_updated": "2021-02-22",
"certification_date": "2021-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IN",
"license": "34008677A",
"primary": true
}
],
"identifiers": [],
"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 Feb 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.