| Moresco-goniu Psychological Services Llc | |
|
7733 W Burleigh St Milwaukee WI 53222-5003 | |
| (262) 347-8848 | |
| Not Available |
| Full Name | Moresco-goniu Psychological Services Llc |
|---|---|
| Speciality | Psychologist |
| Location | 7733 W Burleigh St, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Carol Lynn Moresco-goniu (OWNER/CLINIC DIRECTOR) |
| Authorized Official Contact | 2623478848 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Moresco-goniu Psychological Services Llc N33w23374 Greenbriar Ct Pewaukee WI 53072-5721 Ph: (262) 347-8848 | Moresco-goniu Psychological Services Llc 7733 W Burleigh St Milwaukee WI 53222-5003 Ph: (262) 347-8848 |
| NPI Number | 1942215421 |
|---|---|
| Provider Enumeration Date | 07/30/2006 |
| Last Update Date | 05/30/2024 |
| Certification Date | 05/30/2024 |
| Medicare PECOS PAC ID | 8921019621 |
|---|---|
| Medicare Enrollment ID | O20060509000777 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942215421 | NPI | - | NPPES |
| 39106900 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 1151-057 (Wisconsin) | Primary |
| Provider Name | Carol Lynn Moresco-goniu |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1295788115 PECOS PAC ID: 7810908514 Enrollment ID: I20100824000170 |
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