Provider Demographics
NPI:1720357387
Name:WHITE, ELIZABETH P (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:P
Last Name:WHITE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELIZABET
Other - Middle Name:
Other - Last Name:PELZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:721 AMERICAN AVE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5071
Mailing Address - Country:US
Mailing Address - Phone:262-928-4036
Mailing Address - Fax:262-928-5096
Practice Address - Street 1:721 AMERICAN AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5071
Practice Address - Country:US
Practice Address - Phone:262-928-4036
Practice Address - Fax:262-928-5096
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15569-132101YA0400X
WI7796-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1720357387Medicaid
WI7796-123OtherSTATE LICENSE