Provider Demographics
NPI:1972126563
Name:SASIN, ANNA (MA)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:SASIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:FRYDRYCKA-SASIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:4429 S 500 W
Mailing Address - Street 2:
Mailing Address - City:NEW PALESTINE
Mailing Address - State:IN
Mailing Address - Zip Code:46163-9769
Mailing Address - Country:US
Mailing Address - Phone:317-650-4200
Mailing Address - Fax:
Practice Address - Street 1:4429 S 500 W
Practice Address - Street 2:
Practice Address - City:NEW PALESTINE
Practice Address - State:IN
Practice Address - Zip Code:46163-9769
Practice Address - Country:US
Practice Address - Phone:317-650-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001335A101YM0800X
IN87000924A101YA0400X
IN34003228A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)