Healthcare Provider Details

I. General information

NPI: 1225045776
Provider Name (Legal Business Name): CAROL FALK MSW, LCSW, CADC III
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E PIER ST
PORT WASHINGTON WI
53074-1939
US

IV. Provider business mailing address

1971 WASHINGTON ST STE 200
GRAFTON WI
53024-2125
US

V. Phone/Fax

Practice location:
  • Phone: 262-284-3117
  • Fax: 262-284-3087
Mailing address:
  • Phone: 262-377-6276
  • Fax: 262-377-6289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11476
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2952
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2952-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: