Orlesia Gay Gooseberry, CSAC AND SOCIAL WORK

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

15709-132 Issued in WI

Practice address

1501 Albert St
North Unit Upper
Racine, WI 53404-2713

Phone

(262) 638-2975

NPI assigned

Aug 16, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1345075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347321600000",
    "number": "1578811980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7726 W LISBON AVE",
            "address_2": "APT # 2",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532223945",
            "telephone_number": "414-617-3684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 ALBERT ST",
            "address_2": "NORTH UNIT UPPER",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534042713",
            "telephone_number": "262-638-2975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOOSEBERRY",
        "first_name": "ORLESIA",
        "middle_name": "GAY",
        "name_prefix": "Mrs.",
        "credential": "CSAC AND SOCIAL WORK",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-16",
        "last_updated": "2012-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "WI",
            "license": "10901-120",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "15709-132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Counselor in Racine, WI
• Providers in Racine, WI by specialty
• Addiction (Substance Use Disorder) Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.