Provider Demographics
NPI:1932259942
Name:SADIE, MARIBETH (PHD)
Entity Type:Individual
Prefix:
First Name:MARIBETH
Middle Name:
Last Name:SADIE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ELM GROVE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122
Mailing Address - Country:US
Mailing Address - Phone:262-782-2090
Mailing Address - Fax:262-782-2092
Practice Address - Street 1:500 ELM GROVE RD
Practice Address - Street 2:#100
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122
Practice Address - Country:US
Practice Address - Phone:262-782-2090
Practice Address - Fax:262-782-2092
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1763057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39105000Medicaid
WI39105000Medicaid