Provider Demographics
NPI:1649804311
Name:BROSIUS, KAREN EMILY (LCSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:EMILY
Last Name:BROSIUS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:EMILY
Other - Last Name:MCCULLOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:901 S ROGERS ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-4760
Mailing Address - Country:US
Mailing Address - Phone:812-360-3470
Mailing Address - Fax:
Practice Address - Street 1:901 S ROGERS ST STE 201
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-4760
Practice Address - Country:US
Practice Address - Phone:812-360-3470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002221A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical