MEDICARE: MS. MARIA ANTIONETTE STEVENS

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
1	1041C0700X	Clinical Social Worker	5270120	WI

Other Identifiers

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

General Provider Information

NPI Number	:	1801930383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIA ANTIONETTE STEVENS

Provider Business Mailing Address
First Line	:	2636 N 50TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-2303
Country	:	US
Telephone Number	:	414-445-3927
Fax Number	:

Provider Business Practice Location Address
First Line	:	2821 N 4TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2362
Country	:	US
Telephone Number	:	414-372-3909
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	06/26/2015

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