Provider Demographics
NPI:1730266578
Name:PERIMAN, PATRICIA M (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:PERIMAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:M
Other - Last Name:FITAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:329 BRECK ROAD
Mailing Address - Street 2:
Mailing Address - City:WALES
Mailing Address - State:WI
Mailing Address - Zip Code:53183
Mailing Address - Country:US
Mailing Address - Phone:262-968-5414
Mailing Address - Fax:
Practice Address - Street 1:1126 S. 70TH STREET
Practice Address - Street 2:SUITE S507
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214
Practice Address - Country:US
Practice Address - Phone:414-727-2789
Practice Address - Fax:414-476-8695
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI745-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41004400Medicaid