Provider Demographics
NPI:1760775480
Name:ROXANNE BRUNSMAN LCSW LLC
Entity Type:Organization
Organization Name:ROXANNE BRUNSMAN LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:DENEFF
Authorized Official - Last Name:BRUNSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:765-683-9583
Mailing Address - Street 1:6173 N 100 W
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:IN
Mailing Address - Zip Code:46001-8219
Mailing Address - Country:US
Mailing Address - Phone:765-683-9583
Mailing Address - Fax:765-683-9583
Practice Address - Street 1:6524 CARROLLTON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-1617
Practice Address - Country:US
Practice Address - Phone:765-620-4628
Practice Address - Fax:765-683-9583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003970A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty