Healthcare Provider Details

I. General information

NPI: 1831275320
Provider Name (Legal Business Name): CATHERINE M ANDERSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5873 DUNES HWY STE 2B
PORTAGE IN
46368-1030
US

IV. Provider business mailing address

1079 N 100 E
CHESTERTON IN
46304-9336
US

V. Phone/Fax

Practice location:
  • Phone: 219-309-3726
  • Fax:
Mailing address:
  • Phone: 219-309-3726
  • Fax: 219-395-8798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87000641A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149010628
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34004861A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: