Provider Demographics
NPI:1962567024
Name:CIMPERMAN, ALBERT JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:
Last Name:CIMPERMAN
Suffix:JR
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 1:13035 W BLUEMOUND RD
Mailing Address - Street 2:SUITE100
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-8001
Mailing Address - Country:US
Mailing Address - Phone:262-784-1121
Mailing Address - Fax:262-784-9777
Practice Address - Street 1:13035 W BLUEMOUND RD
Practice Address - Street 2:SUITE100
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-8001
Practice Address - Country:US
Practice Address - Phone:262-784-1121
Practice Address - Fax:262-784-9777
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1469-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1962567024Medicaid
WIS76769Medicare PIN