Provider Demographics
NPI:1730119678
Name:BARAKAT, MUNTHER A (MA AND PSYD)
Entity Type:Individual
Prefix:DR
First Name:MUNTHER
Middle Name:A
Last Name:BARAKAT
Suffix:
Gender:M
Credentials:MA AND PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065 W GREENBRIAR CT
Mailing Address - Street 2:APT 3A
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-8150
Mailing Address - Country:US
Mailing Address - Phone:414-304-7294
Mailing Address - Fax:
Practice Address - Street 1:10500 W LOOMIS RD
Practice Address - Street 2:SUITE 150
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8111
Practice Address - Country:US
Practice Address - Phone:414-858-1014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2780-057103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist