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General NPI Number Information
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NPI Number | 1871691667
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Entity Type | Organization
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Legal Business Name | MICHAEL J. MERVILDE,MSW
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/16/2008
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Provider Practice Location Address
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Address Line | 125 S JEFFERSON ST SUITE 306
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City | GREEN BAY
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State | WI
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Zip | 54301-4500
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Country | US
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Telephone | 920-437-7878
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Fax | 920-437-5884
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Provider Business Mailing Address
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Address Line | 125 S JEFFERSON ST SUITE 306
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City | GREEN BAY
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State | WI
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Zip | 54301-4500
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Country | US
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Telephone | 920-437-7878
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Fax | 920-437-5884
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. KAREN SUE MERVILDE
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Credential |
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Telephone | 920-437-7878
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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 | 107-123
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License Number State | WI
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