MEDICARE: MS. ELIZABETH JEANNE BRANDT M.A.

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	34002548	IN
2	106H00000X	Marriage & Family Therapist	35000196	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11422736	OTHER	IN	CAQH
2	000000350069	OTHER	IN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1700941747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH JEANNE BRANDT M.A.

Provider Business Mailing Address
First Line	:	7002 GRAHAM RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-4057
Country	:	US
Telephone Number	:	317-849-4342
Fax Number	:	317-558-1348

Provider Business Practice Location Address
First Line	:	7002 GRAHAM RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-4057
Country	:	US
Telephone Number	:	317-849-4342
Fax Number	:	317-558-1348

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

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	09/11/2025

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