| Whitestar Wellness Sc | |
|
4685 Pilgrim Rd Brookfield WI 53005-1556 | |
| (414) 630-2743 | |
| Not Available |
| Full Name | Whitestar Wellness Sc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4685 Pilgrim Rd, Brookfield, Wisconsin |
| Authorized Official Name and Position | Ariel Namowicz (OWNER) |
| Authorized Official Contact | 2743414630 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Whitestar Wellness Sc 4685 Pilgrim Rd Brookfield WI 53005-1556 Ph: () - | Whitestar Wellness Sc 4685 Pilgrim Rd Brookfield WI 53005-1556 Ph: (414) 630-2743 |
| NPI Number | 1205566353 |
|---|---|
| Provider Enumeration Date | 06/13/2022 |
| Last Update Date | 09/13/2022 |
| Certification Date | 08/30/2022 |
| Medicare PECOS PAC ID | 1355725102 |
|---|---|
| Medicare Enrollment ID | O20220829002577 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205566353 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Secondary |
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Ariel Marie Namowicz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164068565 PECOS PAC ID: 2264816016 Enrollment ID: I20221112000106 |
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