Provider Demographics
NPI:1346751328
Name:CHA, BRIANNA DANAE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BRIANNA
Middle Name:DANAE
Last Name:CHA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:DANAE
Other - Last Name:UNDERHILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:482 S LANDMARK AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-5000
Mailing Address - Country:US
Mailing Address - Phone:812-333-8474
Mailing Address - Fax:812-961-3804
Practice Address - Street 1:482 S LANDMARK AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-5000
Practice Address - Country:US
Practice Address - Phone:812-333-8474
Practice Address - Fax:812-961-3804
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007955A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical