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General NPI Number Information
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NPI Number | 1144289588
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Entity Type | Individual
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Provider Name | MARY J BRILL LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 11/14/2014
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Provider Practice Location Address
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Address Line | 4433 N OAKLAND AVE SUITE D
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City | SHOREWOOD
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State | WI
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Zip | 53211-1600
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Country | US
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Telephone | 414-906-1445
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Fax | 414-906-1445
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Provider Business Mailing Address
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Address Line | 4433 N OAKLAND AVE SUITE D
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City | SHOREWOOD
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State | WI
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Zip | 53211-1600
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Country | US
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Telephone | 414-906-1445
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Fax | 414-906-1445
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 3677-123
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3677123
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 24293
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License Number State | CA
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