Provider Demographics
NPI:1104661792
Name:SANFILIPPO, ASHLEY NICOLE (LSW)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICOLE
Last Name:SANFILIPPO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11220 DARMSTADT RD
Mailing Address - Street 2:
Mailing Address - City:DARMSTADT
Mailing Address - State:IN
Mailing Address - Zip Code:47725-9523
Mailing Address - Country:US
Mailing Address - Phone:812-660-2624
Mailing Address - Fax:
Practice Address - Street 1:6724 E MORGAN AVE STE B
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-8228
Practice Address - Country:US
Practice Address - Phone:812-401-0797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99120696A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical