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General NPI Number Information
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NPI Number | 1104966563
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Entity Type | Individual
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Provider Name | JUDY M. SANDY LCSW ACSW LCAC
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Gender | Female
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 08/02/2021
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Provider Practice Location Address
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Address Line | 133 N 4TH ST STE 407
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City | LAFAYETTE
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State | IN
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Zip | 47901-1308
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Country | US
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Telephone | 765-420-1643
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Fax | 765-746-3664
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Provider Business Mailing Address
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Address Line | 133 N 4TH ST STE 407
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City | LAFAYETTE
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State | IN
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Zip | 47901-1308
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Country | US
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Telephone | 765-420-1643
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Fax | 765-746-3664
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34000471A
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License Number State | IN
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