Healthcare Provider Details

I. General information

NPI: 1588916373
Provider Name (Legal Business Name): CATHERINE SHEEHAN GAMMA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE SHEEHAN

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 S 76TH ST
MILWAUKEE WI
53214-1599
US

IV. Provider business mailing address

9000 W WISCONSIN AVE # MS 958
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-453-1400
  • Fax: 414-453-2538
Mailing address:
  • Phone: 414-266-7451
  • Fax: 414-266-6238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7860
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: