Provider Demographics
NPI:1679558894
Name:VERLARE, ANN MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:VERLARE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 CUSTER ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4356
Mailing Address - Country:US
Mailing Address - Phone:920-433-3630
Mailing Address - Fax:
Practice Address - Street 1:3415 CUSTER ST
Practice Address - Street 2:SUITE D
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-4356
Practice Address - Country:US
Practice Address - Phone:920-433-3630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI330982OtherMHN TRICARE
WIWI1506002Medicare Oscar/Certification
WI000001Medicare Oscar/Certification
WIP90980Medicare UPIN