Provider Demographics
NPI:1043480635
Name:GERBER, MARY ELLEN (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELLEN
Last Name:GERBER
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 1:8584 W APPLETON AVE
Mailing Address - Street 2:UNIT Y
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-4279
Mailing Address - Country:US
Mailing Address - Phone:414-460-5573
Mailing Address - Fax:
Practice Address - Street 1:4465 N OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-1662
Practice Address - Country:US
Practice Address - Phone:414-460-7753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2637-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical