Provider Demographics
NPI:1790005007
Name:MARTIN-EASH, DORA (LCSW)
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:
Last Name:MARTIN-EASH
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 216
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:IN
Mailing Address - Zip Code:46540-0216
Mailing Address - Country:US
Mailing Address - Phone:260-383-2322
Mailing Address - Fax:260-383-2422
Practice Address - Street 1:505 E NORTH VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SHIPSHEWANA
Practice Address - State:IN
Practice Address - Zip Code:46565-8662
Practice Address - Country:US
Practice Address - Phone:260-383-2322
Practice Address - Fax:260-383-2422
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2023-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006714A1041C0700X
IN33005842A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical