Provider Demographics
NPI:1992043772
Name:ZDROIK, MARY E (CSAC)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:E
Last Name:ZDROIK
Suffix:
Gender:F
Credentials:CSAC
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Mailing Address - Street 1:1225 W MITCHELL ST
Mailing Address - Street 2:#223
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-3383
Mailing Address - Country:US
Mailing Address - Phone:414-383-4455
Mailing Address - Fax:414-727-8730
Practice Address - Street 1:1225 W MITCHELL ST
Practice Address - Street 2:#223
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-3383
Practice Address - Country:US
Practice Address - Phone:414-383-4455
Practice Address - Fax:414-727-8730
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI11450-132101YA0400X
WI5314-120104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5314-120OtherLICENSE-SOCIAL WORKER
WI11450-132OtherLICENSE-CSAC