Basic Information
| Provider Information | |||||||||
| NPI: | 1548852429 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CANTY | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | LPC-IT, SAC-IT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 NORHARDT DR APT 316 | ||||||||
| Address2: | |||||||||
| City: | BROOKFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530455088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307091992 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2814 S 108TH ST | ||||||||
| Address2: | |||||||||
| City: | WEST ALLIS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532273224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4148853525 | ||||||||
| FaxNumber: | 2626434617 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2021 | ||||||||
| LastUpdateDate: | 02/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 4791-226 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.