Provider Demographics
NPI:1366817926
Name:MAROHL, CARLY RAE (MSW, APSW, SAC-IT)
Entity Type:Individual
Prefix:MS
First Name:CARLY
Middle Name:RAE
Last Name:MAROHL
Suffix:
Gender:F
Credentials:MSW, APSW, SAC-IT
Other - Prefix:MRS
Other - First Name:CARLY
Other - Middle Name:RAE
Other - Last Name:MARIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, APSW, SAC-IT
Mailing Address - Street 1:4757 N 76TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-4732
Mailing Address - Country:US
Mailing Address - Phone:414-358-4167
Mailing Address - Fax:414-358-5002
Practice Address - Street 1:4757 N 76TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-4732
Practice Address - Country:US
Practice Address - Phone:414-358-4167
Practice Address - Fax:414-358-5002
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16933-130101YA0400X
WI129904-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)