Provider Demographics
NPI:1083112320
Name:BEYERSDORF, MARIANNE ELIZABETH (LCSW)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:ELIZABETH
Last Name:BEYERSDORF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARIANNE
Other - Middle Name:
Other - Last Name:LOESCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APSW
Mailing Address - Street 1:W175N11120 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-4799
Mailing Address - Country:US
Mailing Address - Phone:888-685-9522
Mailing Address - Fax:622-345-5531
Practice Address - Street 1:2215 N PALMER ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-3242
Practice Address - Country:US
Practice Address - Phone:800-438-1772
Practice Address - Fax:262-345-5562
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1308801041C0700X
WI9486-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical