Provider Demographics
NPI:1710243118
Name:BROPHY, SAMANTHA M (ART THERAPIST / LPC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:M
Last Name:BROPHY
Suffix:
Gender:F
Credentials:ART THERAPIST / LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 W WELLS ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-2720
Mailing Address - Country:US
Mailing Address - Phone:414-937-2251
Mailing Address - Fax:414-937-2021
Practice Address - Street 1:2020 W WELLS STREET
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233
Practice Address - Country:US
Practice Address - Phone:414-937-2251
Practice Address - Fax:414-937-2021
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI104.036101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
104-036OtherWI ART THERAPY LICENSE
WI5300-125OtherWI LPC