MEDICARE: PATTILYNN COSTANZO BARRETT LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	12597-123	WI

General Provider Information

NPI Number	:	1932080892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATTILYNN COSTANZO BARRETT LCSW

Provider Business Mailing Address
First Line	:	2009 N 56TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53208-1609
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1442 S 92ND ST
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53214-4235
Country	:	US
Telephone Number	:	414-731-7452
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2025
Last Update Date	:	01/05/2026

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