Provider Demographics
NPI:1952424988
Name:KREIDER, MARILYN SUE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:SUE
Last Name:KREIDER
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 1:8342 LA HABRA LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-8830
Mailing Address - Country:US
Mailing Address - Phone:317-823-1829
Mailing Address - Fax:
Practice Address - Street 1:11950 FISHERS CROSSING DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2702
Practice Address - Country:US
Practice Address - Phone:317-595-5555
Practice Address - Fax:317-595-5554
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005002A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical