Provider Demographics
NPI:1861245342
Name:FALLAT, ERIN G (MSW, LSW)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:G
Last Name:FALLAT
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 E DUPONT RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1554
Mailing Address - Country:US
Mailing Address - Phone:260-471-8141
Mailing Address - Fax:260-471-7979
Practice Address - Street 1:1010 E DUPONT RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1554
Practice Address - Country:US
Practice Address - Phone:260-471-8141
Practice Address - Fax:260-471-7979
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33011779A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health