MEDICARE: JENAE ELIZABETH HERSHBERGER 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
1	101YM0800X	Mental Health Counselor	34010673A	IN

General Provider Information

NPI Number	:	1942081666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENAE ELIZABETH HERSHBERGER LCSW

Provider Business Mailing Address
First Line	:	67546 COUNTY ROAD 23
Second Line	:
City	:	NEW PARIS
State	:	IN
Zip	:	46553-9718
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	67546 COUNTY ROAD 23
Second Line	:
City	:	NEW PARIS
State	:	IN
Zip	:	46553-9718
Country	:	US
Telephone Number	:	844-309-5236
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2023
Last Update Date	:	10/09/2023

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