Healthcare Provider Details

I. General information

NPI: 1689584575
Provider Name (Legal Business Name): ANTHONY SANDILLA, LCSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 LAKE SUPERIOR RD APT 304
VALPARAISO IN
46383-6743
US

IV. Provider business mailing address

1200 LAKE SUPERIOR RD APT 304
VALPARAISO IN
46383-6743
US

V. Phone/Fax

Practice location:
  • Phone: 219-240-5533
  • Fax: 219-533-4223
Mailing address:
  • Phone: 219-240-5533
  • Fax: 219-533-4223

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: ANTHONY SANDILLA
Title or Position: OWNER
Credential: LCSW
Phone: 219-240-5533