Provider Demographics
NPI:1124386107
Name:SANDERS, EDNA MAE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:EDNA
Middle Name:MAE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250A W 86TH ST # 1043
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-3605
Mailing Address - Country:US
Mailing Address - Phone:317-294-1434
Mailing Address - Fax:317-342-5854
Practice Address - Street 1:5026 CLARKSON DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-4199
Practice Address - Country:US
Practice Address - Phone:317-294-1434
Practice Address - Fax:317-342-5854
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006420A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical