Provider Demographics
NPI:1801930383
Name:STEVENS, MARIA ANTIONETTE
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:ANTIONETTE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:STEVENS
Other - Suffix:V
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:2636 N 50TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-2303
Mailing Address - Country:US
Mailing Address - Phone:414-445-3927
Mailing Address - Fax:
Practice Address - Street 1:2821 N 4TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-2362
Practice Address - Country:US
Practice Address - Phone:414-372-3909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52701201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40914900Medicaid
WI002184330Medicare ID - Type Unspecified