Provider Demographics
NPI:1861436065
Name:ERATH, BARRY D (LCSW)
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:D
Last Name:ERATH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 LENNON ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-1124
Mailing Address - Country:US
Mailing Address - Phone:608-742-7263
Mailing Address - Fax:608-742-3641
Practice Address - Street 1:2639 NEW PINERY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-1110
Practice Address - Country:US
Practice Address - Phone:608-742-5020
Practice Address - Fax:608-742-3641
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2594-123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39541100Medicaid
WI13874OtherDEAN INSURANCE
WI39541100Medicaid