Provider Demographics
NPI:1992479588
Name:SANDERS, STEVEN ROBERT (LCSW)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:ROBERT
Last Name:SANDERS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2143 N BROOKFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46628-3312
Mailing Address - Country:US
Mailing Address - Phone:574-302-1240
Mailing Address - Fax:
Practice Address - Street 1:401 E COLFAX AVE STE 180
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2880
Practice Address - Country:US
Practice Address - Phone:574-302-1240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-06
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34008205A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty