Provider Demographics
NPI:1285140954
Name:KERSCHBAUM, DEBRA ANN (LLMSW)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:KERSCHBAUM
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4730 SCOTTDALE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9317
Mailing Address - Country:US
Mailing Address - Phone:269-429-5180
Mailing Address - Fax:
Practice Address - Street 1:4730 SCOTTDALE RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9317
Practice Address - Country:US
Practice Address - Phone:269-429-5180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010960961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical