Provider Demographics
NPI:1831380880
Name:ERNSBERGER, DAWN RENEE (LCSW)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:RENEE
Last Name:ERNSBERGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 954
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:IN
Mailing Address - Zip Code:46540-0954
Mailing Address - Country:US
Mailing Address - Phone:574-529-1793
Mailing Address - Fax:574-457-3463
Practice Address - Street 1:214 W WARREN ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:IN
Practice Address - Zip Code:46540-9410
Practice Address - Country:US
Practice Address - Phone:574-529-1793
Practice Address - Fax:574-457-3463
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005372A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical