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General NPI Number Information
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NPI Number | 1851590178
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Entity Type | Individual
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Provider Name | RESA DEANNE SANDORA LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/16/2007
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Last Update Date | 04/01/2020
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Provider Practice Location Address
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Address Line | 100 W COURT AVENUE SUITE #203
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-3740
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Country | US
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Telephone | 502-251-1555
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 99296
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City | LOUISVILLE
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State | KY
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Zip | 40269-0296
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Country | US
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Telephone | 407-285-1211
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Fax |
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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 | 252373
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW006259
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34007567A
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License Number State | IN
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