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General NPI Number Information
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NPI Number | 1043480635
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Entity Type | Individual
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Provider Name | MARY ELLEN GERBER LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 03/10/2008
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Provider Practice Location Address
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Address Line | 4465 N OAKLAND AVE
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City | SHOREWOOD
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State | WI
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Zip | 53211-1662
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Country | US
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Telephone | 414-460-7753
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Fax |
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Provider Business Mailing Address
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Address Line | 8584 W APPLETON AVE UNIT Y
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City | MILWAUKEE
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State | WI
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Zip | 53225-4279
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Country | US
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Telephone | 414-460-5573
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2637-123
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License Number State | WI
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