Provider Demographics
NPI:1427129923
Name:FINGERHUT, LAILA PEDERSEN (LCSW LMFT)
Entity type:Individual
Prefix:MRS
First Name:LAILA
Middle Name:PEDERSEN
Last Name:FINGERHUT
Suffix:
Gender:F
Credentials:LCSW LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17917 KILLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-9773
Mailing Address - Country:US
Mailing Address - Phone:574-291-2645
Mailing Address - Fax:574-291-3700
Practice Address - Street 1:17917 KILLINGTON WAY
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-9773
Practice Address - Country:US
Practice Address - Phone:574-291-2645
Practice Address - Fax:574-291-3700
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002895A1041C0700X
IN35001428A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11627900OtherCAQH
IN100113330Medicaid