Healthcare Provider Details

I. General information

NPI: 1891328472
Provider Name (Legal Business Name): BRIAN DILOSA MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6904 73RD AVE
SCHERERVILLE IN
46375-3515
US

IV. Provider business mailing address

6904 73RD AVE
SCHERERVILLE IN
46375-3515
US

V. Phone/Fax

Practice location:
  • Phone: 219-381-5770
  • Fax:
Mailing address:
  • Phone: 219-381-5770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34011072A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number33007671A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: