Provider Demographics
NPI:1043309982
Name:DEMIS, ERNIE (LCSW)
Entity Type:Individual
Prefix:
First Name:ERNIE
Middle Name:
Last Name:DEMIS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 FLORENCITA DRIVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020
Mailing Address - Country:US
Mailing Address - Phone:818-636-2873
Mailing Address - Fax:
Practice Address - Street 1:2303 FLORENCITA DRIVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020
Practice Address - Country:US
Practice Address - Phone:818-636-2873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS-122471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical