Provider Demographics
NPI:1033687686
Name:TILL, DANETTE NORMAN (MS, MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:DANETTE
Middle Name:NORMAN
Last Name:TILL
Suffix:
Gender:F
Credentials:MS, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 BISCAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-1213
Mailing Address - Country:US
Mailing Address - Phone:574-267-7688
Mailing Address - Fax:
Practice Address - Street 1:503 E FORT WAYNE ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3338
Practice Address - Country:US
Practice Address - Phone:574-267-2906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004690A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical