| Trillium Care Group Llc | |
|
500 Elm Grove Rd Suite 100 Elm Grove WI 53122 | |
| (262) 782-2090 | |
| (262) 782-2092 |
| Full Name | Trillium Care Group Llc |
|---|---|
| Speciality | Social Worker |
| Location | 500 Elm Grove Rd, Elm Grove, Wisconsin |
| Authorized Official Name and Position | Teresa C Ortiz (CLINICAL DIRECTOR PSYCHOTHERAPIST) |
| Authorized Official Contact | 2627822090 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Trillium Care Group Llc 500 Elm Grove Rd Suite 100 Elm Grove WI 53122 Ph: (262) 782-2090 | Trillium Care Group Llc 500 Elm Grove Rd Suite 100 Elm Grove WI 53122 Ph: (262) 782-2090 |
| NPI Number | 1477629640 |
|---|---|
| Provider Enumeration Date | 11/28/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 7618935529 |
|---|---|
| Medicare Enrollment ID | O20041223000193 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477629640 | NPI | - | NPPES |
| 42238700 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 2564 (Wisconsin) | Primary |
| 1041C0700X | Social Worker - Clinical | 2564 (Wisconsin) | Primary |
| Provider Name | Cecilia Teresa Ortiz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417007493 PECOS PAC ID: 0547241309 Enrollment ID: I20040527000150 |
| Provider Name | Lucia M Micheli |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770633752 PECOS PAC ID: 1254399165 Enrollment ID: I20050120000618 |
| Provider Name | Maribeth A Sadie |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1932259942 PECOS PAC ID: 0345208252 Enrollment ID: I20050121000016 |
| Provider Name | Jennifer E Foro |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952416034 PECOS PAC ID: 6002824711 Enrollment ID: I20060322000272 |
| Provider Name | David F Timmer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639286552 PECOS PAC ID: 9436242195 Enrollment ID: I20070911000691 |
| Provider Name | Monica Jean Maniaci |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467931931 PECOS PAC ID: 5698149870 Enrollment ID: I20230330001151 |
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