Active NPI
Martin Gordon Millichap, MA
- Clinical Social Worker
- Waukesha, WI
National Provider Identifier
1396808226
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 2351-123
- Practice address
- 514 Riverview Ave
Waukesha, WI 53188-3631 - Phone
- (262) 548-7688
- Fax
- (262) 548-7656
- NPI assigned
- Dec 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 2351-123 | WI | Primary |
Addresses
Primary practice location
514 Riverview Ave
Waukesha, WI 53188-3631
Mailing address
514 Riverview Ave
Waukesha, WI 53188-3631
Phone (262) 548-7688
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39197000 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2351-123 | WI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1386633600000",
"number": "1396808226",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "514 RIVERVIEW AVE",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "531883631",
"telephone_number": "262-548-7688",
"fax_number": "262-548-7656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "514 RIVERVIEW AVE",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "531883631",
"telephone_number": "262-548-7688",
"fax_number": "262-548-7656"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLICHAP",
"first_name": "MARTIN",
"middle_name": "GORDON",
"name_prefix": "Mr.",
"credential": "MA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-19",
"last_updated": "2013-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "2351-123",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39197000",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waukesha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.