| Providence Psychiatric Services S C | |
|
333 Bishops Way Ste 102 Brookfield WI 53005-6209 | |
| (414) 239-3172 | |
| Not Available |
| Full Name | Providence Psychiatric Services S C |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 333 Bishops Way Ste 102, Brookfield, Wisconsin |
| Authorized Official Name and Position | Mary L Pintarro (PRESIDENT) |
| Authorized Official Contact | 4142393172 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Psychiatric Services S C 333 Bishops Way Ste 102 Brookfield WI 53005-6209 Ph: (414) 239-3172 | Providence Psychiatric Services S C 333 Bishops Way Ste 102 Brookfield WI 53005-6209 Ph: (414) 239-3172 |
| NPI Number | 1376272500 |
|---|---|
| Provider Enumeration Date | 06/04/2022 |
| Last Update Date | 06/04/2022 |
| Certification Date | 06/04/2022 |
| Medicare PECOS PAC ID | 1850770637 |
|---|---|
| Medicare Enrollment ID | O20220624001471 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376272500 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Mary Pintarro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689310179 PECOS PAC ID: 2769861541 Enrollment ID: I20220624001529 |
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