Whitmore, Mary Jane

Whitmore, Mary Jane is an individual health care provider with primary practice located at 840 Lake Ave Suite 101, Racine WI 53403-1566. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Whitmore, Mary Jane can be contacted via phone (262) 634-8688.

Contact Information

Primary practice address
840 Lake Ave Suite 101 Racine WI 53403-1566
Phone: (262) 634-8688
Fax: (262) 634-7547
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 7186-123 Wisconsin
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 1623-132 Wisconsin

Profile Details

NPI number 1134175334
LBN Legal business name Whitmore, Mary Jane
Credentials LCSW, CADCIII
Entity Individual
Sole proprietor 1 No
Enumeration date May 26th, 2006
Last updated Jul 12th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1134175334 NPPES
Wisconsin MEDICAID 39341100

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