Provider Demographics
NPI:1245507169
Name:REDAR, VICTORIA RAE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:RAE
Last Name:REDAR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:VICTORIA
Other - Middle Name:RAE
Other - Last Name:SHEETS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:133 N DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-4118
Mailing Address - Country:US
Mailing Address - Phone:219-384-1932
Mailing Address - Fax:
Practice Address - Street 1:104 E CULVER RD STE 106
Practice Address - Street 2:
Practice Address - City:KNOX
Practice Address - State:IN
Practice Address - Zip Code:46534-2241
Practice Address - Country:US
Practice Address - Phone:574-772-7400
Practice Address - Fax:574-772-0299
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
IN34007298A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker