Provider Demographics
NPI:1093429219
Name:NIESPODZIANY, EMMA KATHLEEN DERHEIMER (LCSW)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:KATHLEEN DERHEIMER
Last Name:NIESPODZIANY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15426 BOWIE DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8373
Mailing Address - Country:US
Mailing Address - Phone:260-403-9129
Mailing Address - Fax:
Practice Address - Street 1:15426 BOWIE DR
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8373
Practice Address - Country:US
Practice Address - Phone:260-403-9129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34010099A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical