Healthcare Provider Details

I. General information

NPI: 1013553932
Provider Name (Legal Business Name): MARISOL E. BROST LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2019
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14755 W CAPITOL DR
BROOKFIELD WI
53005-2318
US

IV. Provider business mailing address

6737 W WASHINGTON ST STE 2275
WEST ALLIS WI
53214-5666
US

V. Phone/Fax

Practice location:
  • Phone: 414-292-4182
  • Fax: 414-292-4182
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number11273-123
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11273-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: