Provider Demographics
NPI:1144289588
Name:BRILL, MARY J (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:J
Last Name:BRILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4433 N OAKLAND AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-1600
Mailing Address - Country:US
Mailing Address - Phone:414-906-1445
Mailing Address - Fax:414-906-1445
Practice Address - Street 1:4433 N OAKLAND AVE
Practice Address - Street 2:SUITE D
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-1600
Practice Address - Country:US
Practice Address - Phone:414-906-1445
Practice Address - Fax:414-906-1445
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3677-123104100000X
WI36771231041C0700X
CA242931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIS10056Medicare UPIN
WI39725100Medicaid
WI0215Medicare ID - Type Unspecified