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General NPI Number Information
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NPI Number | 1568982478
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Entity Type | Individual
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Provider Name | SAMOEUTROEUTTEANA MAO BECKETT LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 1433 N WATER ST FL 4
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City | MILWAUKEE
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State | WI
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Zip | 53202-2557
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Country | US
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Telephone | 646-941-7645
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Fax |
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Provider Business Mailing Address
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Address Line | 777 N JEFFERSON ST STE 408
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City | MILWAUKEE
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State | WI
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Zip | 53202-3713
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Country | US
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Telephone |
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 123003
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License Number State | MA
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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 | 10235-123
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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 | 4545
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License Number State | HI
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