Provider Demographics
NPI:1588065775
Name:IDONA, VANESSA M (LCSW, CSAYC, EMDR)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:M
Last Name:IDONA
Suffix:
Gender:F
Credentials:LCSW, CSAYC, EMDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5699 E 71ST ST STE 3A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-3950
Mailing Address - Country:US
Mailing Address - Phone:929-302-6163
Mailing Address - Fax:
Practice Address - Street 1:5699 E 71ST ST STE 3A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-3950
Practice Address - Country:US
Practice Address - Phone:929-302-6163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN43009339A1041C0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program