Healthcare Provider Details

I. General information

NPI: 1912036609
Provider Name (Legal Business Name): PATRICIA ANNE WHITE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 N FARWELL AVE
MILWAUKEE WI
53202-2329
US

IV. Provider business mailing address

3214 N NEWHALL ST
MILWAUKEE WI
53211-3042
US

V. Phone/Fax

Practice location:
  • Phone: 414-273-2220
  • Fax: 414-273-2223
Mailing address:
  • Phone: 414-332-0410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number603124
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: