Healthcare Provider Details

I. General information

NPI: 1710104237
Provider Name (Legal Business Name): MANDY REISMAN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E 3RD ST
RUSHVILLE IN
46173-2208
US

IV. Provider business mailing address

5605 COUNTY ROAD NORTH 20 EAST
GREENSBURG IN
47240
US

V. Phone/Fax

Practice location:
  • Phone: 765-932-5905
  • Fax: 765-938-4545
Mailing address:
  • Phone: 812-527-2868
  • Fax: 765-938-4545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: