| Family Therapy Center Of Madison, Inc. | |
|
700 Ray O Vac Dr Suite 220 Madison WI 53711-2479 | |
| (608) 276-9191 | |
| (608) 276-9144 |
| Full Name | Family Therapy Center Of Madison, Inc. |
|---|---|
| Speciality | Social Worker |
| Location | 700 Ray O Vac Dr, Madison, Wisconsin |
| Authorized Official Name and Position | Carol Faynik (PRESIDENT/TREASURER) |
| Authorized Official Contact | 6082769191 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Therapy Center Of Madison, Inc. 700 Ray O Vac Dr Suite 220 Madison WI 53711-2479 Ph: (608) 276-9191 | Family Therapy Center Of Madison, Inc. 700 Ray O Vac Dr Suite 220 Madison WI 53711-2479 Ph: (608) 276-9191 |
| NPI Number | 1164587150 |
|---|---|
| Provider Enumeration Date | 12/27/2006 |
| Last Update Date | 10/25/2013 |
| Medicare PECOS PAC ID | 1850285826 |
|---|---|
| Medicare Enrollment ID | O20040211000028 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164587150 | NPI | - | NPPES |
| 42111900 | Medicaid | WI |
| Provider Name | Judith A Utevsky |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043244247 PECOS PAC ID: 5991694853 Enrollment ID: I20040311000047 |
| Provider Name | Marie K Udulutch |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1851376149 PECOS PAC ID: 5698731636 Enrollment ID: I20041202000041 |
| Provider Name | Nancy J Leff |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124073499 PECOS PAC ID: 9537171392 Enrollment ID: I20060615000317 |
| Provider Name | Barbara L Loevinger |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225127038 PECOS PAC ID: 0446359483 Enrollment ID: I20070615000526 |
| Provider Name | Sabrina C Loomis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952522484 PECOS PAC ID: 2062562663 Enrollment ID: I20090602000297 |
| Provider Name | Anne S Beal |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245395425 PECOS PAC ID: 9830083815 Enrollment ID: I20101201000579 |
| Provider Name | Jean S Bae |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1093870073 PECOS PAC ID: 8022902097 Enrollment ID: I20101203001151 |
| Provider Name | Melinda M Bailey |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1699830869 PECOS PAC ID: 3476447459 Enrollment ID: I20110105000628 |
| Provider Name | Carol J Faynik |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164587366 PECOS PAC ID: 4183518160 Enrollment ID: I20110126001067 |
| Provider Name | Amanda L Case |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972710713 PECOS PAC ID: 2062677107 Enrollment ID: I20120622000486 |
| Provider Name | Kirsten G Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114159266 PECOS PAC ID: 2860535028 Enrollment ID: I20161028000585 |
| Provider Name | Elizabeth Michelle Hudson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497931737 PECOS PAC ID: 8628480746 Enrollment ID: I20201215001113 |
| Provider Name | Maureen G White |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1679988083 PECOS PAC ID: 0446608897 Enrollment ID: I20231127001607 |
| Provider Name | Amy V Kucin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750599031 PECOS PAC ID: 3971730805 Enrollment ID: I20231222002341 |
| Provider Name | Jordyn F Ackerman |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1750825030 PECOS PAC ID: 4880044072 Enrollment ID: I20240101000126 |
| Provider Name | Kathleen Cook |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1407951767 PECOS PAC ID: 2961853973 Enrollment ID: I20240103004121 |
| Provider Name | Mary B Mcauliffe |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1093131104 PECOS PAC ID: 0446509913 Enrollment ID: I20240115001336 |
| Provider Name | Aimee Harris |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1700498912 PECOS PAC ID: 6406208917 Enrollment ID: I20240120000282 |
| Provider Name | Kathryn Lynn Mazack |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1194497313 PECOS PAC ID: 1850743287 Enrollment ID: I20240122000774 |
| Provider Name | Mary E. Batson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1194008557 PECOS PAC ID: 8628327194 Enrollment ID: I20240126003409 |
| Provider Name | Marcia Marie Leaser |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1093148330 PECOS PAC ID: 6406297282 Enrollment ID: I20240510000796 |
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