Provider Demographics
NPI:1295856219
Name:LAYDEN, MARY BETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:BETH
Last Name:LAYDEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4402 SOUTH 68TH STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-3479
Mailing Address - Country:US
Mailing Address - Phone:262-506-4050
Mailing Address - Fax:
Practice Address - Street 1:4402 SOUTH 68TH STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-3479
Practice Address - Country:US
Practice Address - Phone:262-506-4050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1295856219Medicaid
WI000284137Medicare ID - Type Unspecified