Provider Demographics
NPI:1649585324
Name:AGRAWAL, NEERAJ (LPC, MA)
Entity type:Individual
Prefix:
First Name:NEERAJ
Middle Name:
Last Name:AGRAWAL
Suffix:
Gender:M
Credentials:LPC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7332 W STATE ST # LL
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2766
Mailing Address - Country:US
Mailing Address - Phone:414-628-3457
Mailing Address - Fax:414-240-9345
Practice Address - Street 1:7332 W STATE ST # LL
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-2766
Practice Address - Country:US
Practice Address - Phone:414-628-3457
Practice Address - Fax:414-240-9345
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11544101YA0400X
WI2847101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43553100Medicaid
WI242647OtherVALUE OPTIONS