Provider Demographics
NPI:1407264047
Name:NEFF, MARY E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:NEFF
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 N PORT WASHINGTON ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4928
Mailing Address - Country:US
Mailing Address - Phone:414-962-6764
Mailing Address - Fax:414-962-6765
Practice Address - Street 1:5555 N PORT WASHINGTON ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53217-4928
Practice Address - Country:US
Practice Address - Phone:414-962-6764
Practice Address - Fax:414-962-6765
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5392 - 125101YP2500X
WI3280-57103TC0700X
WI3280-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100039912Medicaid