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General NPI Number Information
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NPI Number | 1760775480
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Entity Type | Organization
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Legal Business Name | ROXANNE BRUNSMAN LCSW LLC
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Dates
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Enumeration Date | 05/27/2011
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Last Update Date | 05/27/2011
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Provider Practice Location Address
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Address Line | 6524 CARROLLTON AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46220-1617
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Country | US
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Telephone | 765-620-4628
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Fax | 765-683-9583
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Provider Business Mailing Address
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Address Line | 6173 N 100 W
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City | ALEXANDRIA
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State | IN
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Zip | 46001-8219
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Country | US
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Telephone | 765-683-9583
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Fax | 765-683-9583
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MS. ROXANNE DENEFF BRUNSMAN
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Credential | LCSW
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Telephone | 765-683-9583
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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 | 34003970A
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License Number State | IN
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