Provider Demographics
NPI:1598082182
Name:GROSDANIS, IRENE M (LCSW)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:M
Last Name:GROSDANIS
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 1:1301 DOMKE DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-7935
Mailing Address - Country:US
Mailing Address - Phone:219-242-9635
Mailing Address - Fax:
Practice Address - Street 1:1301 DOMKE DR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-7935
Practice Address - Country:US
Practice Address - Phone:219-242-9635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-22
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX308961041C0700X
IN34006918A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical