Provider Demographics
NPI:1568982478
Name:BECKETT, SAMOEUTROEUTTEANA MAO (LCSW)
Entity type:Individual
Prefix:
First Name:SAMOEUTROEUTTEANA
Middle Name:MAO
Last Name:BECKETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SAMOEUTROEUTTEANA
Other - Middle Name:MICHELLE
Other - Last Name:MAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:777 N JEFFERSON ST STE 408
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1433 N WATER ST FL 4
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2557
Practice Address - Country:US
Practice Address - Phone:646-941-7645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1230031041C0700X
WI10235-1231041C0700X
HI45451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical