Provider Demographics
NPI:1851590178
Name:SANDORA, RESA DEANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RESA
Middle Name:DEANNE
Last Name:SANDORA
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:PO BOX 99296
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40269-0296
Mailing Address - Country:US
Mailing Address - Phone:407-285-1211
Mailing Address - Fax:
Practice Address - Street 1:100 W COURT AVENUE SUITE #203
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3740
Practice Address - Country:US
Practice Address - Phone:502-251-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2523731041C0700X
FLSW0062591041C0700X
IN34007567A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical