| Psychiatric & Psychotherapy Clinic L I Newman Md Sc Gen Ptr | |
|
3601 30th Ave Ste 102 Kenosha WI 53144-1642 | |
| (262) 654-0487 | |
| (262) 654-2434 |
| Full Name | Psychiatric & Psychotherapy Clinic L I Newman Md Sc Gen Ptr |
|---|---|
| Speciality | Counselor |
| Location | 3601 30th Ave Ste 102, Kenosha, Wisconsin |
| Authorized Official Name and Position | Paul M Defazio (OWNER) |
| Authorized Official Contact | 2626540487 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychiatric & Psychotherapy Clinic L I Newman Md Sc Gen Ptr 3601 30th Ave Ste 102 Kenosha WI 53144-1642 Ph: (262) 654-0487 | Psychiatric & Psychotherapy Clinic L I Newman Md Sc Gen Ptr 3601 30th Ave Ste 102 Kenosha WI 53144-1642 Ph: (262) 654-0487 |
| NPI Number | 1932312212 |
|---|---|
| Provider Enumeration Date | 05/07/2007 |
| Last Update Date | 08/11/2011 |
| Medicare PECOS PAC ID | 0547200198 |
|---|---|
| Medicare Enrollment ID | O20050503001288 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932312212 | NPI | - | NPPES |
| 42124700 | Medicaid | WI |
| Provider Name | Valerie J Earl |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598847030 PECOS PAC ID: 8224094024 Enrollment ID: I20041203000322 |
| Provider Name | Corrie R Lee |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275652315 PECOS PAC ID: 6608973920 Enrollment ID: I20070522000307 |
| Provider Name | Pushparanee Babusukumar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003919697 PECOS PAC ID: 4486740222 Enrollment ID: I20071010000093 |
| Provider Name | Ashokkumar K Shah |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1730246380 PECOS PAC ID: 8628257763 Enrollment ID: I20110121000615 |
| Provider Name | Paul M Defazio |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740326370 PECOS PAC ID: 7416997069 Enrollment ID: I20110322000935 |
| Provider Name | Lisa M Defazio |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336374925 PECOS PAC ID: 9638352594 Enrollment ID: I20110330000638 |
| Provider Name | Mary Girsh-jensen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578961181 PECOS PAC ID: 1456671882 Enrollment ID: I20150526001320 |
| Provider Name | Amy Lynn Clark |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851898233 PECOS PAC ID: 9931456209 Enrollment ID: I20180717003993 |
| Provider Name | Jessica Rummel Busch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891260097 PECOS PAC ID: 2961756895 Enrollment ID: I20181113001517 |
| Provider Name | Kelly Sue Renzoni |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659918324 PECOS PAC ID: 0244664324 Enrollment ID: I20191224000277 |
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