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Contact Information

CHRIS DIEDERICH, LCSW
2040 N SHADELAND AVE
STE 250
INDIANAPOLIS, IN46219-1711
 Phone: 317-355-5009
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

1041C0700X 80 Licensed Clinical Social Worker
 

Addiction (Substance Use Disorder)

101YA0400X
Indicates primary specialty

NPI Profile & details for CHRIS DIEDERICH · (Male)

NPI # 1821016700
Status Active
Credentials LCSW (Licensed Clinical Social Worker)
Entity Individual
Enumeration date 07/18/2006
Last updated 04/12/2018 - About 8 years ago
Sole proprietor 1 No
Identifiers
  • IN License # 34004362A
  • IN License # 39000598A
  • IN Other 000000390191 ANTHEM BCBS PROVIDER PIN
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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