Provider Demographics
NPI:1962517979
Name:GERBER, JAMES JOSEPH (LCSW)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:JOSEPH
Last Name:GERBER
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 1:4811 S 76TH ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4364
Mailing Address - Country:US
Mailing Address - Phone:262-542-3255
Mailing Address - Fax:414-817-0442
Practice Address - Street 1:4811 S 76TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4364
Practice Address - Country:US
Practice Address - Phone:262-542-3255
Practice Address - Fax:414-817-0442
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3715-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI392333000Medicaid
WIP23095Medicare UPIN