Provider Demographics
NPI:1679906952
Name:READ, MARINA (CSAC)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:READ
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSAC
Mailing Address - Street 1:721 AMERICAN AVE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5071
Mailing Address - Country:US
Mailing Address - Phone:262-928-4036
Mailing Address - Fax:
Practice Address - Street 1:1126 S 70TH ST
Practice Address - Street 2:113-3
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-3151
Practice Address - Country:US
Practice Address - Phone:414-475-2788
Practice Address - Fax:414-476-8695
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16033-132101YA0400X
WI2092101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI16906-130OtherWI STATE LICENSE