=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629174040
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY CATHERINE HARGARTEN MSW, LCSW, LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2006
-----------------------------------------------------
Last Update Date | 01/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | W156N8327 PILGRIM RD SUITE 302
-----------------------------------------------------
City | MENOMONEE FALLS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53051-3776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-251-1112
-----------------------------------------------------
Fax | 262-251-1113
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5561 N MOHAWK AVE
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53217-5034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-964-9894
-----------------------------------------------------
Fax | 414-964-6041
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 7107123
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 676124
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------