Active NPI
Susan Gail Sandock, LCSW
- Clinical Social Worker
- South Bend, IN
National Provider Identifier
1043622798
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 34004026A
- Practice address
- 919 E Jefferson Blvd Ste 401
South Bend, IN 46617-3117 - Phone
- (574) 287-4197
- NPI assigned
- May 29, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 34004026A | IN | Primary |
Addresses
Primary practice location
919 E Jefferson Blvd Ste 401
South Bend, IN 46617-3117
Mailing address
919 E Jefferson Blvd Ste 401
South Bend, IN 46617-3117
Phone (574) 287-4197
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34004026A | IN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1401321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1401321600000",
"number": "1043622798",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "919 E JEFFERSON BLVD STE 401",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466173117",
"telephone_number": "574-287-4197"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "919 E JEFFERSON BLVD STE 401",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466173117",
"telephone_number": "574-287-4197"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDOCK",
"first_name": "SUSAN",
"middle_name": "GAIL",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-05-29",
"last_updated": "2014-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IN",
"license": "34004026A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.