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Individual

EMILY LUSTIG

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSW

Contact information

Practice address
1409 EMIL ST, MADISON, WI 53713-2311
(608) 283-6426
Mailing address
1409 EMIL ST, MADISON, WI 53713-2311
(608) 283-6426

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
19022
WI
104100000X
Social Worker
Primary
131454
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
131454
ADVANCED PRACTICE SOCIAL WORKER
WI
01
19022
SUBSTANCE ABUSE COUNSELOR-IN-TRAINING
WI
Enumeration date
11/08/2021
Last updated
11/08/2021
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