| Mary Determan Msw, Llc | |
|
5757 W Oklahoma Ave Suite 203 Milwaukee WI 53219-4303 | |
| (414) 431-6400 | |
| (414) 431-6401 |
| Full Name | Mary Determan Msw, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 5757 W Oklahoma Ave, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Maryellen Rozga (BUSINESS MANAGER) |
| Authorized Official Contact | 4144316400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Determan Msw, Llc 5757 W Oklahoma Ave Suite 203 Milwaukee WI 53219-4303 Ph: (414) 431-6400 | Mary Determan Msw, Llc 5757 W Oklahoma Ave Suite 203 Milwaukee WI 53219-4303 Ph: (414) 431-6400 |
| NPI Number | 1861524365 |
|---|---|
| Provider Enumeration Date | 03/10/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 0345211991 |
|---|---|
| Medicare Enrollment ID | O20040805000613 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861524365 | NPI | - | NPPES |
| 42235600 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 2357 (Wisconsin) | Primary |
| Provider Name | Mary M Determan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003948522 PECOS PAC ID: 8022089689 Enrollment ID: I20070720000040 |
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