Provider Demographics
NPI:1073132387
Name:SCHRAA, MARYBETH M (LCSW)
Entity Type:Individual
Prefix:
First Name:MARYBETH
Middle Name:M
Last Name:SCHRAA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARYBETH
Other - Middle Name:M
Other - Last Name:HORDYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:414-342-4560
Mailing Address - Fax:
Practice Address - Street 1:3200 W HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-3252
Practice Address - Country:US
Practice Address - Phone:414-342-4560
Practice Address - Fax:414-342-5326
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI94181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100098876Medicaid