MEDICARE: CYNTHIA B DESADIER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	1041C0700X	IN
2	1041C0700X	Clinical Social Worker	34001586A	IN
3	106H00000X	Marriage & Family Therapist	35000577A	IN
4	101YM0800X	Mental Health Counselor	39000970A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000176598	OTHER	IN	ANTHEM ID

General Provider Information

NPI Number	:	1609932870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA B DESADIER LCSW

Provider Business Mailing Address
First Line	:	4000 W 106TH ST # 125-206
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46032-7720
Country	:	US
Telephone Number	:	317-334-1693
Fax Number	:	317-993-3122

Provider Business Practice Location Address
First Line	:	2020 W 86TH ST
Second Line	:	SUITE 305
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1969
Country	:	US
Telephone Number	:	317-334-1692
Fax Number	:	317-334-3693

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	09/03/2024

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Directions to “ CYNTHIA B DESADIER LCSW” Practice Location

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