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General NPI Number Information
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NPI Number | 1891711222
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Entity Type | Organization
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Legal Business Name | NEERAJ AGRAWAL CLINIC LTD
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 08/17/2010
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Provider Practice Location Address
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Address Line | 7332 W STATE ST # LL
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City | WAUWATOSA
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State | WI
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Zip | 53213-2766
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Country | US
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Telephone | 414-628-3457
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Fax | 262-252-4874
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Provider Business Mailing Address
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Address Line | 11450 N CONCORD CREEK DR
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City | MEQUON
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State | WI
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Zip | 53092-4387
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Country | US
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Telephone | 414-628-3457
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Fax | 262-252-4874
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Authorized Official
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Title or Position | DIRECTOR & PSYCHOTHERAPIST
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Name | DR. NEERAJ B AGRAWAL
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Credential | MA, SAC, LPC
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Telephone | 414-628-3457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 11544
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2847125
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License Number State | WI
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