Individual
CARISSA SANDOVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
480 EVERSMAN DR, JASPER, IN 47546-3548
(812) 482-3020
Mailing address
480 EVERSMAN DR, JASPER, IN 47546-3548
(812) 482-3020
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34009167A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3700-03-6622
NPPES
IN
Enumeration date
09/02/2021
Last updated
09/02/2021
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