Provider Demographics
NPI:1336147099
Name:EVERHART, SHOSHANNA (MSW)
Entity Type:Individual
Prefix:
First Name:SHOSHANNA
Middle Name:
Last Name:EVERHART
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W RAMPART ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-8846
Mailing Address - Country:US
Mailing Address - Phone:317-421-2012
Mailing Address - Fax:317-398-1852
Practice Address - Street 1:15 S TOMPKINS ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-1205
Practice Address - Country:US
Practice Address - Phone:317-392-0171
Practice Address - Fax:317-392-0171
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003554A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200057860Medicaid
IN200057860Medicaid