Provider Demographics
NPI:1740212505
Name:BRUNSMAN, ROXANNE D (MSW,LCSW)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:D
Last Name:BRUNSMAN
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6173 NORTH 100 WEST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:IN
Mailing Address - Zip Code:46001
Mailing Address - Country:US
Mailing Address - Phone:765-620-4628
Mailing Address - Fax:765-683-9583
Practice Address - Street 1:9135 NORTH MERIDIAN ST
Practice Address - Street 2:SUITE A-9
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260
Practice Address - Country:US
Practice Address - Phone:765-620-4628
Practice Address - Fax:765-683-9583
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003970A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN146290AMedicare PIN