Healthcare Provider Details

I. General information

NPI: 1144657883
Provider Name (Legal Business Name): JASMITA RANCHOD LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2013
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 W HOSPITAL ROAD
PAOLI IN
47454
US

IV. Provider business mailing address

480 EVERSMAN DRIVE
JASPER IN
47547-0769
US

V. Phone/Fax

Practice location:
  • Phone: 812-723-4301
  • Fax: 812-723-4306
Mailing address:
  • Phone: 812-482-3020
  • Fax: 812-482-6409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number99058690A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: