Provider Demographics
NPI:1538278650
Name:PERLEBERG, NANCY (MS, LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:PERLEBERG
Suffix:
Gender:F
Credentials:MS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5303 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-1021
Mailing Address - Country:US
Mailing Address - Phone:414-445-0997
Mailing Address - Fax:414-445-0989
Practice Address - Street 1:5303 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-1021
Practice Address - Country:US
Practice Address - Phone:414-445-0997
Practice Address - Fax:414-445-0989
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI187-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40960200Medicaid