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General NPI Number Information
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NPI Number | 1427553452
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Entity Type | Individual
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Provider Name | JARED MITCHELL BROSCHART MSW, LCSW
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Gender | Male
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Dates
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Enumeration Date | 03/30/2018
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 1928 S DAN JONES RD
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City | AVON
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State | IN
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Zip | 46123-6678
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Country | US
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Telephone | 317-854-8265
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Fax | 877-895-7698
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Provider Business Mailing Address
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Address Line | 220 N MERIDIAN ST APT 806
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City | INDIANAPOLIS
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State | IN
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Zip | 46204-2373
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Country | US
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Telephone | 317-966-2372
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34008077A
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License Number State | IN
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