Provider Demographics
NPI:1427553452
Name:BROSCHART, JARED MITCHELL (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:JARED
Middle Name:MITCHELL
Last Name:BROSCHART
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
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Mailing Address - Street 1:220 N MERIDIAN ST APT 806
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-2373
Mailing Address - Country:US
Mailing Address - Phone:317-966-2372
Mailing Address - Fax:
Practice Address - Street 1:1928 S DAN JONES RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6678
Practice Address - Country:US
Practice Address - Phone:317-854-8265
Practice Address - Fax:877-895-7698
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34008077A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN34008077AOtherLICENSE