Provider Demographics
NPI:1629696083
Name:DEMILIO, BARBARA GAIL (LCSW)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:GAIL
Last Name:DEMILIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8662 WESTLAKE DR
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-1071
Mailing Address - Country:US
Mailing Address - Phone:414-708-0109
Mailing Address - Fax:
Practice Address - Street 1:6214 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-3986
Practice Address - Country:US
Practice Address - Phone:262-456-3712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6744-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical