| Riverwalk Psychotherapy Associates, Llc | |
|
1110 N. Old World Third St. Suite 401 Milwaukee WI 53203 | |
| (414) 224-0800 | |
| (414) 224-0883 |
| Full Name | Riverwalk Psychotherapy Associates, Llc |
|---|---|
| Speciality | General Practice |
| Location | 1110 N. Old World Third St., Milwaukee, Wisconsin |
| Authorized Official Name and Position | Serena Courtney Clardie (PARTNER/PSYCHOTHERAPIST) |
| Authorized Official Contact | 4142240800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Riverwalk Psychotherapy Associates, Llc 1110 N. Old World Third St. Suite 401 Milwaukee WI 53203 Ph: (608) 423-3960 | Riverwalk Psychotherapy Associates, Llc 1110 N. Old World Third St. Suite 401 Milwaukee WI 53203 Ph: (414) 224-0800 |
| NPI Number | 1073687349 |
|---|---|
| Provider Enumeration Date | 11/20/2006 |
| Last Update Date | 06/10/2014 |
| Medicare PECOS PAC ID | 5092752691 |
|---|---|
| Medicare Enrollment ID | O20050414001078 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073687349 | NPI | - | NPPES |
| 42184700 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Serena C Clardie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891704854 PECOS PAC ID: 5294754362 Enrollment ID: I20051117000519 |
| Provider Name | Heather J Hart Kennedy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942379888 PECOS PAC ID: 0749469732 Enrollment ID: I20110124000116 |
| Provider Name | Regina V Goodman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184865347 PECOS PAC ID: 5395985501 Enrollment ID: I20130711000832 |
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