1790775021 NPI number — SUSAN JEAN CRANNY LCSW

Table of content: SUSAN JEAN CRANNY LCSW (NPI 1790775021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790775021 NPI number — SUSAN JEAN CRANNY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRANNY
Provider First Name:
SUSAN
Provider Middle Name:
JEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALLARDICE
Provider Other First Name:
SUSAN
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790775021
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6267 LAKELAND LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46234-3071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-858-0158
Provider Business Mailing Address Fax Number:
317-535-8749

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
540 TRACY RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
NEW WHITELAND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46184-9699
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-535-0513
Provider Business Practice Location Address Fax Number:
317-535-8749
Provider Enumeration Date:
10/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  34002045A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000176163 . This is a "ANTHEM BCBS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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