Provider Demographics
NPI:1831275320
Name:ANDERSON, CATHERINE M (LCSW)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:ANDERSON
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 1:1079 N 100 E
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-9336
Mailing Address - Country:US
Mailing Address - Phone:219-309-3726
Mailing Address - Fax:219-395-8798
Practice Address - Street 1:5873 DUNES HWY STE 2B
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-1030
Practice Address - Country:US
Practice Address - Phone:219-309-3726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000641A101YA0400X
IL1490106281041C0700X
IN34004861A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1831275320OtherCAQH
IN200684470Medicaid