Provider Demographics
NPI:1467023366
Name:MATHIS, JOSCELYN ELAINE (MSW, LSW, FSW)
Entity Type:Individual
Prefix:MS
First Name:JOSCELYN
Middle Name:ELAINE
Last Name:MATHIS
Suffix:
Gender:F
Credentials:MSW, LSW, FSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 N GALE ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46218-3832
Mailing Address - Country:US
Mailing Address - Phone:317-313-0126
Mailing Address - Fax:
Practice Address - Street 1:1633 N CAPITOL AVE STE 300
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1467
Practice Address - Country:US
Practice Address - Phone:317-962-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33008804A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker