Provider Demographics
NPI:1073626537
Name:ERNSBERGER, DEAN WILLIAM (LBSW)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:WILLIAM
Last Name:ERNSBERGER
Suffix:
Gender:M
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 S ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:MARINE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48039-3409
Mailing Address - Country:US
Mailing Address - Phone:810-765-5363
Mailing Address - Fax:
Practice Address - Street 1:515 S PARKER ST STE D
Practice Address - Street 2:
Practice Address - City:MARINE CITY
Practice Address - State:MI
Practice Address - Zip Code:48039-3553
Practice Address - Country:US
Practice Address - Phone:810-765-5010
Practice Address - Fax:810-765-8451
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802084843104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker