Provider Demographics
NPI:1841219169
Name:DEMET, MARY JANE M (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MARY JANE
Middle Name:M
Last Name:DEMET
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 1:731 N JACKSON ST
Mailing Address - Street 2:STE 510
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-4697
Mailing Address - Country:US
Mailing Address - Phone:414-810-2256
Mailing Address - Fax:
Practice Address - Street 1:731 N JACKSON ST
Practice Address - Street 2:STE 510
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-4697
Practice Address - Country:US
Practice Address - Phone:414-810-2256
Practice Address - Fax:888-266-8068
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3960-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39783600Medicaid
WI002084911Medicare PIN