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NPI Code Detail

MEDICARE: DAWN RENEE ERNSBERGER LCSW

MEDICARE: DAWN RENEE ERNSBERGER LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker34005372AIN

General Provider Information

NPI Number : 1831380880
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAWN RENEE ERNSBERGER LCSW
Provider Business Mailing Address
First Line : PO BOX 954
Second Line :
City : MIDDLEBURY
State : IN
Zip : 46540-0954
Country : US
Telephone Number : 574-529-1793
Fax Number : 574-457-3463
Provider Business Practice Location Address
First Line : 214 W WARREN ST
Second Line :
City : MIDDLEBURY
State : IN
Zip : 46540-9410
Country : US
Telephone Number : 574-529-1793
Fax Number : 574-457-3463
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2007
Last Update Date : 08/06/2007

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