Provider Demographics
NPI:1427029834
Name:ANGEBRANDT, DORIAN (LCSW)
Entity type:Individual
Prefix:
First Name:DORIAN
Middle Name:
Last Name:ANGEBRANDT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-1269
Mailing Address - Country:US
Mailing Address - Phone:317-346-6252
Mailing Address - Fax:317-245-2367
Practice Address - Street 1:901 N MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-1269
Practice Address - Country:US
Practice Address - Phone:317-346-6252
Practice Address - Fax:317-245-2367
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005036A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200952220AMedicaid