Provider Demographics
NPI:1982572673
Name:MARKWARDT, SAMUEL BRADLEY (LCSW)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:BRADLEY
Last Name:MARKWARDT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 S 67TH PL
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53219-2006
Mailing Address - Country:US
Mailing Address - Phone:414-688-7614
Mailing Address - Fax:
Practice Address - Street 1:2245 S 67TH PL
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53219-2006
Practice Address - Country:US
Practice Address - Phone:414-688-7614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-25
Last Update Date:2025-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI131453-1211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical