Provider Demographics
NPI:1851785935
Name:BRAVARD, SUSAN H (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:H
Last Name:BRAVARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7822 WEDGETAIL DR
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-4421
Mailing Address - Country:US
Mailing Address - Phone:317-440-2704
Mailing Address - Fax:
Practice Address - Street 1:1650 W OAK ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1962
Practice Address - Country:US
Practice Address - Phone:317-912-1399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000558A1041C0700X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No174H00000XOther Service ProvidersHealth Educator