Provider Demographics
NPI:1346381241
Name:DATI, DAVID (LCSW, LMFT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DATI
Suffix:
Gender:M
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16798 GAULT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:WI
Mailing Address - Zip Code:54634-3375
Mailing Address - Country:US
Mailing Address - Phone:608-627-1221
Mailing Address - Fax:
Practice Address - Street 1:16798 GAULT VALLEY RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:WI
Practice Address - Zip Code:54634-3375
Practice Address - Country:US
Practice Address - Phone:608-627-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2507-1231041C0700X
WI350-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39617300Medicaid
WIS08745Medicare UPIN
WI39617300Medicaid