| Samuel Lustgarten Phd Llc | |
|
702 N Blackhawk Ave Ste 205 Madison WI 53705-3357 | |
| (720) 260-4362 | |
| (971) 999-0817 |
| Full Name | Samuel Lustgarten Phd Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 702 N Blackhawk Ave Ste 205, Madison, Wisconsin |
| Authorized Official Name and Position | Samuel David Lustgarten (LICENSED PSYCHOLOGIST/OWNER) |
| Authorized Official Contact | 7202604362 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Samuel Lustgarten Phd Llc 702 N Blackhawk Ave Ste 205 Madison WI 53705-3357 Ph: (720) 260-4362 | Samuel Lustgarten Phd Llc 702 N Blackhawk Ave Ste 205 Madison WI 53705-3357 Ph: (720) 260-4362 |
| NPI Number | 1427729227 |
|---|---|
| Provider Enumeration Date | 09/22/2021 |
| Last Update Date | 12/23/2022 |
| Certification Date | 12/23/2022 |
| Medicare PECOS PAC ID | 8921473505 |
|---|---|
| Medicare Enrollment ID | O20230413000113 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427729227 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Samuel David Lustgarten |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1477197929 PECOS PAC ID: 9830564418 Enrollment ID: I20230413000140 |
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