Provider Demographics
NPI:1225045776
Name:FALK, CAROL (MSW, LCSW, CADC III)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:FALK
Suffix:
Gender:F
Credentials:MSW, LCSW, CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1971 WASHINGTON ST
Mailing Address - Street 2:STE 200
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-2125
Mailing Address - Country:US
Mailing Address - Phone:262-377-6276
Mailing Address - Fax:262-377-6289
Practice Address - Street 1:101 E PIER ST
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:WI
Practice Address - Zip Code:53074-1939
Practice Address - Country:US
Practice Address - Phone:262-284-3117
Practice Address - Fax:262-284-3087
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11476101YA0400X
WI2952104100000X
WI2952-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40908400Medicaid
WIP32066Medicare UPIN