Healthcare Provider Details

I. General information

NPI: 1588575252
Provider Name (Legal Business Name): MORIAH WHITE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 W CAPITOL DR
MILWAUKEE WI
53222-1706
US

IV. Provider business mailing address

W201N16589 HEMLOCK ST
JACKSON WI
53037-9563
US

V. Phone/Fax

Practice location:
  • Phone: 414-465-5770
  • Fax: 414-260-8980
Mailing address:
  • Phone: 262-573-2912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13096-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: