Provider Demographics
NPI:1437326444
Name:LUZADER, MARK B (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:B
Last Name:LUZADER
Suffix:
Gender:M
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:PO BOX 3276
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47731-3276
Mailing Address - Country:US
Mailing Address - Phone:812-473-0181
Mailing Address - Fax:812-473-5822
Practice Address - Street 1:7300 E INDIANA ST
Practice Address - Street 2:STE 103
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2794
Practice Address - Country:US
Practice Address - Phone:812-401-8008
Practice Address - Fax:812-401-8201
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001005745OtherANTHEM BCBS
IN34005693OtherLICENSE
IN100240880Medicaid