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Contact Information

IVY PETRA, LCSW, LCAC
213 MIDDLEBURY ST
GOSHEN, IN46528
 Phone: 574-534-3300
 Fax: 574-534-5412
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

1041C0700X 80 Licensed Clinical Social Worker
 

Addiction (Substance Use Disorder)

101YA0400X
Indicates primary specialty

NPI Profile & details for IVY PETRA · (Female)

NPI Number 1538592704
Status Active
Credentials LCSW, LCAC
Entity Individual
Enumeration date 08/12/2013
Last updated 12/31/2020 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • IN License # 34006676A
  • IN License # 87001243A
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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