Healthcare Provider Details

I. General information

NPI: 1255776365
Provider Name (Legal Business Name): SARAH ELIZABETH BRILL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH ELIZABETH BRILL LCSW

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4433 N OAKLAND AVE STE D
SHOREWOOD WI
53211
US

IV. Provider business mailing address

4433 N OAKLAND AVE STE D
SHOREWOOD WI
53211
US

V. Phone/Fax

Practice location:
  • Phone: 414-906-1445
  • Fax: 414-906-1445
Mailing address:
  • Phone: 414-906-1445
  • Fax: 414-906-1445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7969-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: