Provider Demographics
NPI:1689675373
Name:VANDERMAN, MARY (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:VANDERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:VANDERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSCSW
Mailing Address - Street 1:9200 INDIAN CREEK PKWY STE 380
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2008
Mailing Address - Country:US
Mailing Address - Phone:913-220-2450
Mailing Address - Fax:913-220-2423
Practice Address - Street 1:9200 INDIAN CREEK PKWY STE 380
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2008
Practice Address - Country:US
Practice Address - Phone:913-220-2450
Practice Address - Fax:913-220-2423
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4012101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0515100130Medicaid
AL1769COtherLCSW
ALQ46972Medicare UPIN
AL051527632VANMedicare Oscar/Certification