Individual provider Active NPI

Marilyn Ann Metz, MSW

  • Clinical Social Worker
  • Milwaukee, WI
National Provider Identifier
1083810634
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
109-123 Issued in WI
Practice address
3953 N 76TH St
Suite 305
Milwaukee, WI 53222-3059
Phone
(414) 616-2292
Fax
(414) 616-2296
NPI assigned
Jun 21, 2007
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 109-123 WI Primary

Addresses

Primary practice location

3953 N 76TH St
Suite 305
Milwaukee, WI 53222-3059

Mailing address

6540 W English Meadows Dr
J203
Greenfield, WI 53220-5405
Phone (414) 727-0955

Other identifiers 1

IdentifierTypeStateIssuer
39274900MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
109-123WIMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1083810634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6540 W ENGLISH MEADOWS DR",
            "address_2": "J203",
            "city": "GREENFIELD",
            "state": "WI",
            "postal_code": "532205405",
            "telephone_number": "414-727-0955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3953 N 76TH ST",
            "address_2": "SUITE 305",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532223059",
            "telephone_number": "414-616-2292",
            "fax_number": "414-616-2296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "METZ",
        "first_name": "MARILYN",
        "middle_name": "ANN",
        "credential": "MSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-21",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "109-123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39274900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.