| Diverse Clinical Services Associates, Inc. | |
|
633 W Wisconsin Ave Suite 330 Milwaukee WI 53203-1918 | |
| (414) 347-4063 | |
| (414) 347-4075 |
| Full Name | Diverse Clinical Services Associates, Inc. |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 633 W Wisconsin Ave, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Basilisa Virella (DIRECTOR) |
| Authorized Official Contact | 4143477063 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Diverse Clinical Services Associates, Inc. 633 W Wisconsin Ave Suite 330 Milwaukee WI 53203-1918 Ph: (414) 347-4063 | Diverse Clinical Services Associates, Inc. 633 W Wisconsin Ave Suite 330 Milwaukee WI 53203-1918 Ph: (414) 347-4063 |
| NPI Number | 1528160314 |
|---|---|
| Provider Enumeration Date | 09/02/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528160314 | NPI | - | NPPES |
| 42206700 | Medicaid | WI | |
| 39704500 | Medicaid | WI | |
| 31786300 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | 2692-123 (Wisconsin) | Primary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 27318020 (Wisconsin) | Primary |
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