Provider Demographics
NPI:1609932870
Name:DESADIER, CYNTHIA B (LCSW)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:B
Last Name:DESADIER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:B
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4000 W 106TH ST # 125-206
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7720
Mailing Address - Country:US
Mailing Address - Phone:317-334-1693
Mailing Address - Fax:317-993-3122
Practice Address - Street 1:2020 W 86TH ST
Practice Address - Street 2:SUITE 305
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1969
Practice Address - Country:US
Practice Address - Phone:317-334-1692
Practice Address - Fax:317-334-3693
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1041C0700X101YM0800X
IN34001586A1041C0700X
IN35000577A106H00000X
IN39000970A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000176598OtherANTHEM ID