Healthcare Provider Details

I. General information

NPI: 1063335875
Provider Name (Legal Business Name): CARISSA ANDERSON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N 13TH ST STE 200
DECATUR IN
46733-3139
US

IV. Provider business mailing address

1401 N 13TH ST STE 200
DECATUR IN
46733-3139
US

V. Phone/Fax

Practice location:
  • Phone: 260-724-2145
  • Fax: 260-728-3867
Mailing address:
  • Phone: 260-724-2145
  • Fax: 260-728-3867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number99137872A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: