Provider Demographics
NPI:1659083475
Name:STEVENS, CHINYERE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:CHINYERE
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 W FOREST HOME AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-3228
Mailing Address - Country:US
Mailing Address - Phone:414-567-5400
Mailing Address - Fax:414-567-5359
Practice Address - Street 1:1432 W FOREST HOME AVE STE 400
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-3228
Practice Address - Country:US
Practice Address - Phone:414-567-5400
Practice Address - Fax:414-567-5359
Is Sole Proprietor?:No
Enumeration Date:2022-12-23
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10004-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1659083475Medicaid