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General NPI Number Information
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NPI Number | 1518674787
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Entity Type | Individual
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Provider Name | DAVID GREGORY ANTHONY LCSW
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Gender | Male
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Dates
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Enumeration Date | 10/27/2022
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Last Update Date | 10/27/2022
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Provider Practice Location Address
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Address Line | 2500 OVERLOOK TER BLDG 7
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City | MADISON
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State | WI
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Zip | 53705-2254
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Country | US
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Telephone | 608-280-7073
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Fax |
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Provider Business Mailing Address
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Address Line | 6117 CREAMERY CT
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City | MCFARLAND
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State | WI
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Zip | 53558-9010
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Country | US
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Telephone | 608-358-2850
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 132089
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License Number State | WI
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