| None | |
|
3800 N Mayfair Rd Wauwatosa WI 53222-2213 | |
| (414) 536-8333 | |
| (414) 536-8348 |
| Full Name | None |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 3800 N Mayfair Rd, Wauwatosa, Wisconsin |
| Authorized Official Name and Position | Deborah S Bauer (PSYCHOTHERAPIST) |
| Authorized Official Contact | 4145368333 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| None 3800 N Mayfair Rd Wauwatosa WI 53222-2213 Ph: (414) 536-8333 | None 3800 N Mayfair Rd Wauwatosa WI 53222-2213 Ph: (414) 536-8333 |
| NPI Number | 1518978659 |
|---|---|
| Provider Enumeration Date | 08/11/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518978659 | NPI | - | NPPES |
| 40932700 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 6932123 (Wisconsin) | Primary |
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