Individual
MS. DIANE ROSE CARR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
16535 W BLUEMOUND RD, SUITE 200, BROOKFIELD, WI 53005-5936
(262) 789-1191
(262) 821-6180
Mailing address
415 LAKE ST, MUKWONAGO, WI 53149-1328
(262) 363-5152
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1100-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40957700
—
WI
Enumeration date
09/12/2006
Last updated
07/08/2007
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