Healthcare Provider Details

I. General information

NPI: 1326180027
Provider Name (Legal Business Name): ROBERTA JEAN HANUS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3022 N CAMBRIDGE AVE
MILWAUKEE WI
53211-3217
US

IV. Provider business mailing address

3022 N CAMBRIDGE AVE
MILWAUKEE WI
53211-3217
US

V. Phone/Fax

Practice location:
  • Phone: 414-332-1658
  • Fax: 414-229-5311
Mailing address:
  • Phone: 414-332-1658
  • Fax: 414-229-5311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW#2767-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: