Provider Demographics
NPI:1073118329
Name:BIRTIC, BRIANNE (LCSW)
Entity type:Individual
Prefix:
First Name:BRIANNE
Middle Name:
Last Name:BIRTIC
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 1:2930 CLEARWATER LN APT 209
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-6897
Mailing Address - Country:US
Mailing Address - Phone:262-719-8266
Mailing Address - Fax:
Practice Address - Street 1:2930 CLEARWATER LN APT 209
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-6897
Practice Address - Country:US
Practice Address - Phone:262-719-8266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI113211041C0700X
WI1299891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical