Michael J. Mervilde,MSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

107-123 Issued in WI

Legal business name

MICHAEL J. MERVILDE,MSW

Doing business as

d/b/a Green Bay Wellness & Behavioral Health Clinic

Practice address

125 S Jefferson St
Suite 306
Green Bay, WI 54301-4500

Phone

(920) 437-7878

Fax

(920) 437-5884

NPI assigned

Sep 20, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Karen Sue Mervilde

Title

Office Manager

Phone

(920) 437-7878

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• d/b/a Green Bay Wellness & Behavioral Health Clinic Doing business as

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216166400000",
    "number": "1871691667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 S JEFFERSON ST",
            "address_2": "SUITE 306",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543014500",
            "telephone_number": "920-437-7878",
            "fax_number": "920-437-5884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 S JEFFERSON ST",
            "address_2": "SUITE 306",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543014500",
            "telephone_number": "920-437-7878",
            "fax_number": "920-437-5884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL J. MERVILDE,MSW",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2008-07-16",
        "status": "A",
        "authorized_official_last_name": "MERVILDE",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "920-437-7878",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "107-123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42158800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "d/b/a Green Bay Wellness & Behavioral Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Imran Hamayun Mian
• Shamoon Mian, PA-C
• Mary Miceli-Wink, CSAC
• Rick D Miceli-Wink, CSAC
• Michael J Pierquet DDS SC
• Michael J. Smullen, MD
• Megan Michaelchuck
• Anthony Peter Michalski
• Lawrence E Michalski, RPH
• Erin Michelfelder

• Clinical Social Worker in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2008; 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.