Provider Demographics
NPI:1699870824
Name:ROUSSEAU, CATHERINE QUINN (LCSW#)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:QUINN
Last Name:ROUSSEAU
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 1:203 W COVENTRY CT APT 103
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-3982
Mailing Address - Country:US
Mailing Address - Phone:414-412-3826
Mailing Address - Fax:
Practice Address - Street 1:203 W COVENTRY CT APT 103
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-3982
Practice Address - Country:US
Practice Address - Phone:414-412-3826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3491-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical