Provider Demographics
NPI:1902581143
Name:MEYER, MARY A (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:MEYER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ANGELA
Other - Last Name:BARTELME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3313 S 79TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53219-3826
Mailing Address - Country:US
Mailing Address - Phone:141-488-1808
Mailing Address - Fax:
Practice Address - Street 1:3313 S 79TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53219-3826
Practice Address - Country:US
Practice Address - Phone:141-488-1808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9516-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical