Provider Demographics
NPI:1164999272
Name:MAYER, MADISON M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MADISON
Middle Name:M
Last Name:MAYER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MADISON
Other - Middle Name:M
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6510 GRAND TETON PLZ STE 402
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1029
Mailing Address - Country:US
Mailing Address - Phone:855-458-4966
Mailing Address - Fax:
Practice Address - Street 1:6510 GRAND TETON PLZ STE 402
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1029
Practice Address - Country:US
Practice Address - Phone:855-458-4699
Practice Address - Fax:608-841-1200
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI130239104100000X
WI9238-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker