Pederson, Sanford Lloyd
Pederson, Sanford Lloyd is an individual health care provider with primary practice located at 494 S Emerson Ave Suite C, Greenwood IN 46143-1912. He recently has 8 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical Neuropsychologist, Behavioral Health & Social Service Providers / Psychologist, Behavioral Health & Social Service Providers / Adult Development & Aging, Behavioral Health & Social Service Providers / Forensic, Behavioral Health & Social Service Providers / Health, Behavioral Health & Social Service Providers / Health Service, Behavioral Health & Social Service Providers / Rehabilitation, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Pederson, Sanford Lloyd can be contacted via phone (317) 889-3901.Contact Information
Primary practice address
494 S Emerson Ave Suite C
Greenwood IN 46143-1912
Phone: (317) 889-3901
Fax: (317) 889-3902
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical Neuropsychologist | 103G00000X | 20041487 | Indiana |
| Behavioral Health & Social Service Providers / Psychologist | 103T00000X | 20041487 | Indiana |
| Behavioral Health & Social Service Providers / Adult Development & Aging | 103TA0700X | 20041487 | Indiana |
| Behavioral Health & Social Service Providers / Forensic | 103TF0200X | 20041487 | Indiana |
| Behavioral Health & Social Service Providers / Health | 103TH0004X | 20041487 | Indiana |
| Behavioral Health & Social Service Providers / Health Service | 103TH0100X | 20041487 | Indiana |
| Behavioral Health & Social Service Providers / Rehabilitation | 103TR0400X | 20041487 | Indiana |
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 20041487 | Indiana |
Profile Details
| NPI number | 1659589885 |
|---|---|
| LBN Legal business name | Pederson, Sanford Lloyd |
| Credentials | PH.D., HSPP |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 20th, 2007 |
| Last updated | Jun 7th, 2024 - about 6 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1659589885 | NPPES |
| Other | 225420 | MEDICATE PTAN | |
| Other | 225420A | MEDICATE PTAN | |
| MEDICAID | 200227370 | MEDICATE PTAN |
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