Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ivy Petra, LCSW, LCAC

Individual provider Addiction (Substance Use Disorder) Counselor · NPI 1538592704

Ivy Petra, LCSW, LCAC is a Clinical Social Worker in Goshen, Indiana. Qualified in 2009, 17 years ago. Practices with Maple City Health Care Center Inc, a 30-clinician group, works from 4 locations and accepts Medicare assignment. Licensed in Indiana.

Years since qualifying
17
Licensed in
IN
In the registry since
2013
Specialties on file
2
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

See every abbreviation used in this directory →

Practice location Address checks out

213 Middlebury St
Goshen, IN 46528
Phone: (574) 534-3300
Fax: (574) 534-5412
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (3)

  • 2600 Oakland Ave, Elkhart, IN 46517-1533 — (574) 533-1234
  • 2600 Oakland Ave, Elkhart, IN 46517-1533 — (574) 533-1234
  • 808 N 3rd St, Goshen, IN 46528-7100 — (574) 534-0088

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 34006676A (IN)
Addiction (Substance Use Disorder) Counselor Taxonomy 101YA0400X · Licence 87001243A (IN)

Record details

NPI number1538592704
Entity typeIndividual (Type 1)
GenderFemale
Credentials LCSW , LCAC
Sole proprietorNo
NPI enumeratedAugust 12, 2013
Last updated in NPPESDecember 31, 2020
Certification dateDecember 31, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2009 (17 years in practice)
Group practice Maple City Health Care Center Inc — 30 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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