MEDICARE: MARY RUTH BRANSTETTER LCSW

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	1041C0700X	Clinical Social Worker	34005320A	IN

General Provider Information

NPI Number	:	1407704349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY RUTH BRANSTETTER LCSW

Provider Business Mailing Address
First Line	:	945 LEMAY DR
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47712-9140
Country	:	US
Telephone Number	:	812-480-0504
Fax Number	:

Provider Business Practice Location Address
First Line	:	6221 PHYSICIANS CT
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47715-4031
Country	:	US
Telephone Number	:	812-480-0504
Fax Number	:

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

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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