Provider Demographics
NPI:1124100417
Name:ANDIS, SHERYL A (MSSW; LCSW; LMFT)
Entity type:Individual
Prefix:MS
First Name:SHERYL
Middle Name:A
Last Name:ANDIS
Suffix:
Gender:F
Credentials:MSSW; LCSW; LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 BELLEMEADE AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0102
Mailing Address - Country:US
Mailing Address - Phone:812-477-2350
Mailing Address - Fax:812-477-2378
Practice Address - Street 1:3700 BELLEMEADE AVE
Practice Address - Street 2:STE 110
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0102
Practice Address - Country:US
Practice Address - Phone:812-477-2350
Practice Address - Fax:812-477-2378
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002024A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INR34352Medicare UPIN
IN161950Medicare ID - Type Unspecified