Provider Demographics
NPI:1528828175
Name:TOLIVER, GERARD DANIEL
Entity type:Individual
Prefix:
First Name:GERARD
Middle Name:DANIEL
Last Name:TOLIVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 N 44TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-3542
Mailing Address - Country:US
Mailing Address - Phone:414-530-0098
Mailing Address - Fax:
Practice Address - Street 1:3212 N 44TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-3542
Practice Address - Country:US
Practice Address - Phone:414-530-0098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health