| Kintsugi Mental Health Llc | |
|
119 Martin Luther King Jr Blvd Ste Ll-20 Madison WI 53703-3355 | |
| (608) 291-3586 | |
| Not Available |
| Full Name | Kintsugi Mental Health Llc |
|---|---|
| Speciality | Psychologist |
| Location | 119 Martin Luther King Jr Blvd Ste Ll-20, Madison, Wisconsin |
| Authorized Official Name and Position | Jaime Lam (OWNER/LICENSED PSYCHOLOGIST) |
| Authorized Official Contact | 7816989171 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kintsugi Mental Health Llc 5902 Tolman Ter Madison WI 53711-3360 Ph: (781) 698-9171 | Kintsugi Mental Health Llc 119 Martin Luther King Jr Blvd Ste Ll-20 Madison WI 53703-3355 Ph: (608) 291-3586 |
| NPI Number | 1679336077 |
|---|---|
| Provider Enumeration Date | 01/30/2024 |
| Last Update Date | 03/06/2024 |
| Certification Date | 03/06/2024 |
| Medicare PECOS PAC ID | 2769822238 |
|---|---|
| Medicare Enrollment ID | O20240501000756 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679336077 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | (* (Not Available)) | Primary |
| Provider Name | Jaime Lam |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1932684735 PECOS PAC ID: 5496195968 Enrollment ID: I20240501000821 |
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