Provider Demographics
NPI:1376594226
Name:HARTMANN-HEISSERER, SANDRA T (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:T
Last Name:HARTMANN-HEISSERER
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 1:11221 BAYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-9097
Mailing Address - Country:US
Mailing Address - Phone:317-823-7471
Mailing Address - Fax:
Practice Address - Street 1:2345 S LYNHURST DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-8630
Practice Address - Country:US
Practice Address - Phone:317-247-8918
Practice Address - Fax:317-381-0619
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005040A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000388451OtherANTHEM BCBS PROVIDER PIN
IN000000388451OtherANTHEM BCBS PROVIDER PIN