Provider Demographics
NPI:1295878460
Name:RENSBERGER, ERIC DEAN (MS, LCSW)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:DEAN
Last Name:RENSBERGER
Suffix:
Gender:M
Credentials:MS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N COLLEGE AVE
Mailing Address - Street 2:SUITE 113
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-3972
Mailing Address - Country:US
Mailing Address - Phone:812-335-4147
Mailing Address - Fax:
Practice Address - Street 1:115 N COLLEGE AVE
Practice Address - Street 2:SUITE 113
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3972
Practice Address - Country:US
Practice Address - Phone:812-335-4147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002812101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health