Doctor Name: | MR. FRED HENRY MALESEVICH |
NPI Number: | 1396752598 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW, ACSW, DAPA |
License Number: | 62-123 |
Business Practice Address: | S110w30520 Ymca Camp Rd Mukwonago, WI - 531499534 |
Business Phone Number: | 2627771833 |
Business Fax Number: | |
Mailing Address: | S110 W30520 Ymca Camp Rd, MUKWONAGO |
State: | WI |
Postal Code: | 531499534 |
Phone Number: | 2627771833 |
Fax Number: | |
NPI Enumeration Date: | 08/01/2006 |
NPI Last Update Date: | 09/18/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 62-123 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |