Provider Demographics
NPI:1568283638
Name:DOBRANSKY, JACOB DANIEL (LMSW)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:DANIEL
Last Name:DOBRANSKY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52355 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46637-2956
Mailing Address - Country:US
Mailing Address - Phone:574-323-5541
Mailing Address - Fax:
Practice Address - Street 1:420 N NILES AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-1918
Practice Address - Country:US
Practice Address - Phone:574-647-8245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33008291A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty