MEDICARE: SHORESIDE THERAPIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	2138-123	WI
2	101YM0800X	Mental Health Counselor	2844-125	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2524	OTHER	WI	CERT MH OUTPATIENT CLINIC

General Provider Information

NPI Number	:	1134334063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHORESIDE THERAPIES

Provider Business Mailing Address
First Line	:	4530 N OAKLAND AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-1215
Country	:	US
Telephone Number	:	414-332-7000
Fax Number	:	414-332-2368

Provider Business Practice Location Address
First Line	:	4530 N OAKLAND AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-1215
Country	:	US
Telephone Number	:	414-332-7000
Fax Number	:	414-332-2368

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	NANCY SHERTOK
Credential	:	MSW,LCSW
Telephone Number	:	414-332-7000

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	09/11/2025

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Directions to “SHORESIDE THERAPIES ” Practice Location

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