Provider Demographics
NPI:1386803914
Name:GERAGHTY, TERESA (MSW LCSW)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:GERAGHTY
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 WATERTOWN PLANK ROAD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3558
Mailing Address - Country:US
Mailing Address - Phone:414-257-6921
Mailing Address - Fax:414-454-4242
Practice Address - Street 1:9201 WATERTOWN PLANK ROAD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3558
Practice Address - Country:US
Practice Address - Phone:414-257-6921
Practice Address - Fax:414-454-4242
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7751231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI10062926Medicaid