MEDICARE: JEROME JORMAN SR. MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	PENDING	IN
2	101YM0800X	Mental Health Counselor	PENDING	IN

General Provider Information

NPI Number	:	1265221907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEROME JORMAN SR. MS

Provider Business Mailing Address
First Line	:	2060 N DELAWARE ST APT 3
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1552
Country	:	US
Telephone Number	:	317-397-4421
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 N POST RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4246
Country	:	US
Telephone Number	:	317-210-9647
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2025
Last Update Date	:	04/30/2025

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