Individual
MARY C EBERLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSW
Contact information
Practice address
1116 N 16TH ST, LAFAYETTE, IN 47904-2119
(765) 423-6300
(765) 423-6301
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(175) 284-8003
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34007491A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34007491A
LICENSE
IN
Enumeration date
07/09/2015
Last updated
06/05/2023
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