Provider Demographics
NPI:1528206455
Name:MARSH, ELISABETH M (MSW, APSW, SAC-IT)
Entity Type:Individual
Prefix:MS
First Name:ELISABETH
Middle Name:M
Last Name:MARSH
Suffix:
Gender:F
Credentials:MSW, APSW, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1568 N WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2265
Mailing Address - Country:US
Mailing Address - Phone:610-462-7262
Mailing Address - Fax:
Practice Address - Street 1:1568 N WARREN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2265
Practice Address - Country:US
Practice Address - Phone:610-462-7262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI127645-1211041C0700X
WI15757-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)