Maribeth Rose Dettlaff, MSW, LCSW, CADC is a
Social Worker - Clinical based in Waukesha, Wisconsin. Maribeth Rose Dettlaff is licensed to practice in Wisconsin (license number 521-123) and her current practice location is
500 Riverview Ave Ste 2, Waukesha, Wisconsin. She can be reached at her office (for appointments etc.) via phone at
(262) 548-7399.
NPI number for Maribeth Rose Dettlaff is 1629132840 and her current mailing address is W168s7024 Parkland Dr, Muskego, Wisconsin. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1629132840.
Healthcare Provider's Profile
Full Name | Maribeth Rose Dettlaff |
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Gender | Female |
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Speciality | Social Worker - Clinical |
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Location | 500 Riverview Ave Ste 2, Waukesha, Wisconsin |
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Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
NPI Data:
- NPI Number: 1629132840
- Provider Enumeration Date: 12/21/2006
- Last Update Date: 07/08/2007
Medical Identifiers
Medical identifiers for Maribeth Rose Dettlaff such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1629132840 | NPI | - | NPPES |
39572300 | Other | WI | T-19 PROVIDER NUMBER |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
101YA0400X | Counselor - Addiction (substance Use Disorder) | 12548 (Wisconsin) | Primary |
1041C0700X | Social Worker - Clinical | 521-123 (Wisconsin) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Maribeth Rose Dettlaff is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Maribeth Rose Dettlaff, MSW, LCSW, CADC W168s7024 Parkland Dr, Muskego, WI 53150-9441 Ph: (414) 422-0708 | Maribeth Rose Dettlaff, MSW, LCSW, CADC 500 Riverview Ave Ste 2, Waukesha, WI 53188-3632 Ph: (262) 548-7399 |
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