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NPI Code Detail

MEDICARE: ST. ROSE YOUTH & FAMILY CENTER, INC

MEDICARE: ST. ROSE YOUTH & FAMILY CENTER, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor1876WI
2101YM0800XMental Health Counselor1876WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740460708
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. ROSE YOUTH & FAMILY CENTER, INC
Provider Business Mailing Address
First Line : 3801 N 88TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53222-2706
Country : US
Telephone Number : 414-466-9450
Fax Number : 414-466-0730
Provider Business Practice Location Address
First Line : 3801 N 88TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53222-2706
Country : US
Telephone Number : 414-466-9450
Fax Number : 414-466-0730
Authorized Official
Title or Position : CEO/PRESIDENT
Name : MR. JAMES MARO
Credential : LCSW
Telephone Number : 414-466-9450
Provider Enumeration Date : 11/07/2007
Last Update Date : 11/07/2007

Similar Medicare Providers

1689847964 — MRS. MARY ELIZABETH KLAHR CSAC
Practice Location Address:
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Practice Fax: 414-466-0730
1306019682 — MS. DENISE ANNE CASSIDY LCSW
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1598938821 — JAMES M MARO LCSW
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1356508535 — ST ROSE YOUTH & FAMILY CENTER INC
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3801 N 88TH ST
MILWAUKEE, WI
53222-2706
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Practice Fax: 414-466-0730
1003051822 — MAUREEN M MULCAHY RN
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1144544776 — REBECCA BARNES
Practice Location Address:
3801 N 88TH ST
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Practice Fax:

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