Provider Demographics
NPI:1851668669
Name:MASTALARZ, MICHELE MARIE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:MARIE
Last Name:MASTALARZ
Suffix:
Gender:F
Credentials:MSW, LCSW
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Other - First Name:
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Mailing Address - Street 1:207 E BUFFALO ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202
Mailing Address - Country:US
Mailing Address - Phone:414-262-3751
Mailing Address - Fax:414-262-3751
Practice Address - Street 1:207 E BUFFALO ST
Practice Address - Street 2:SUITE 510
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-5739
Practice Address - Country:US
Practice Address - Phone:262-375-1116
Practice Address - Fax:262-375-1071
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI8124-1231041C0700X
WI128508-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI128508-121OtherAPSW
WI8124-123OtherSTATE OF WI DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES, LCSW