Healthcare Provider Details

I. General information

NPI: 1336074517
Provider Name (Legal Business Name): AVARIE GOLDSMITH BSW, MSW
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 S COUNTY ROAD 450 E
AVON IN
46123-8434
US

IV. Provider business mailing address

752 N LELAND AVE
INDIANAPOLIS IN
46219-4347
US

V. Phone/Fax

Practice location:
  • Phone: 317-742-1700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number99136880A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: