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Contact Information

CLEANSE CLINIC JEFFERSONVILLE LLC
1700 STATE ST
NEW ALBANY, IN47150-4916
 Phone: 812-914-7038
 Fax: 812-748-6035
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Addiction Psychiatry

2084P0802X 86 Physician/Neuropsychiatry
Indicates primary specialty

NPI Profile & details for CLEANSE CLINIC JEFFERSONVILLE LLC · (Female)

NPI Number 1942728472
Status Active
Credentials
Entity Individual
Enumeration date 09/05/2017
Last updated 01/31/2024 - About 2 years ago
Sole proprietor 1 Not specified
Identifiers
  • IN License # 1784-0-ASO
  • IN Medicaid 300008912
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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