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

Individual provider Clinical Social Worker · NPI 1558441717

Jinny Renee Broderick, LCSW is a Clinical Social Worker in Fort Wayne, Indiana. Qualified in 2002, 24 years ago. Practices with Park Center Inc, a 47-clinician group and accepts Medicare assignment. Licensed in Indiana.

Years since qualifying
24
Licensed in
IN
In the registry since
2006
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

909 E State Blvd
Fort Wayne, IN 46805-3404
Phone: (260) 481-2700
Fax: (260) 481-2709
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 34005183A (IN)

Record details

NPI number1558441717
Entity typeIndividual (Type 1)
GenderFemale
Credentials LCSW
Sole proprietorNo
NPI enumeratedOctober 16, 2006
Last updated in NPPESSeptember 29, 2010

Medicare enrollment

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

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2002 (24 years in practice)
Group practice Park Center Inc — 47 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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