Provider Demographics
NPI:1710104237
Name:REISMAN, MANDY (MSW)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:REISMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5605 COUNTY ROAD NORTH 20 EAST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47240
Mailing Address - Country:US
Mailing Address - Phone:812-527-2868
Mailing Address - Fax:765-938-4545
Practice Address - Street 1:121 E 3RD ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IN
Practice Address - Zip Code:46173-2208
Practice Address - Country:US
Practice Address - Phone:765-932-5905
Practice Address - Fax:765-938-4545
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker