Provider Demographics
NPI:1790775021
Name:CRANNY, SUSAN JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JEAN
Last Name:CRANNY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:JEAN
Other - Last Name:ALLARDICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6267 LAKELAND LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-3071
Mailing Address - Country:US
Mailing Address - Phone:317-858-0158
Mailing Address - Fax:317-535-8749
Practice Address - Street 1:540 TRACY RD
Practice Address - Street 2:SUITE C
Practice Address - City:NEW WHITELAND
Practice Address - State:IN
Practice Address - Zip Code:46184-9699
Practice Address - Country:US
Practice Address - Phone:317-535-0513
Practice Address - Fax:317-535-8749
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002045A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000176163OtherANTHEM BCBS
IN344840EEMedicare ID - Type Unspecified