Provider Demographics
NPI:1245391739
Name:PUFF, SUE A (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:A
Last Name:PUFF
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 LAKE AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-5397
Mailing Address - Country:US
Mailing Address - Phone:260-424-0411
Mailing Address - Fax:260-424-3530
Practice Address - Street 1:2200 LAKE AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5397
Practice Address - Country:US
Practice Address - Phone:260-424-0411
Practice Address - Fax:260-424-3530
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003392A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000182397OtherANTHEM
IN000000182397OtherANTHEM