Provider Demographics
NPI:1972633360
Name:MYOTA, MARGARET E (LCSW)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:E
Last Name:MYOTA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:E
Other - Last Name:MYOTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:10500 N PORT WASHINGTON RD
Mailing Address - Street 2:100
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5585
Mailing Address - Country:US
Mailing Address - Phone:262-719-0030
Mailing Address - Fax:262-719-0030
Practice Address - Street 1:10500 N PORT WASHINGTON RD
Practice Address - Street 2:100
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5585
Practice Address - Country:US
Practice Address - Phone:262-719-0030
Practice Address - Fax:262-719-0030
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI675-123104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker