| None | |
|
2745 W Layton Ave Suite 102 Milwaukee WI 53221-2651 | |
| (414) 282-1152 | |
| (414) 282-5485 |
| Full Name | None |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 2745 W Layton Ave, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Maximo Librada Cueto (PRESIDENT) |
| Authorized Official Contact | 4142821152 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| None 2745 W Layton Ave Suite 102 Milwaukee WI 53221-2651 Ph: (414) 282-1152 | None 2745 W Layton Ave Suite 102 Milwaukee WI 53221-2651 Ph: (414) 282-1152 |
| NPI Number | 1730440470 |
|---|---|
| Provider Enumeration Date | 05/30/2012 |
| Last Update Date | 05/30/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730440470 | NPI | - | NPPES |
| 3010-7800 | Medicaid | WI | |
| 000073674 | Other | WI | MEDICARE |
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