Healthcare Provider Details

I. General information

NPI: 1104420090
Provider Name (Legal Business Name): HEATHER SRNCIK, LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9783 E 116TH ST # 199
FISHERS IN
46037-2822
US

IV. Provider business mailing address

9783 E 116TH ST # 199
FISHERS IN
46037-2822
US

V. Phone/Fax

Practice location:
  • Phone: 317-648-9295
  • Fax:
Mailing address:
  • Phone: 317-648-9295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: HEATHER A SRNCIK
Title or Position: LCSW
Credential: LCSW
Phone: 317-648-9295