Provider Demographics
NPI:1497881759
Name:MAYFIELD, CHARLOTTE DELORES (MSW, CAPSW)
Entity Type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:DELORES
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:MSW, CAPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 N 64TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2727
Mailing Address - Country:US
Mailing Address - Phone:414-445-8720
Mailing Address - Fax:
Practice Address - Street 1:4929 W FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2324
Practice Address - Country:US
Practice Address - Phone:414-871-6122
Practice Address - Fax:414-871-2552
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI126904-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker