Wisconsin Psychology Associates, Llc | |
318 Margaret Ct Burlington WI 53105-2330 | |
(812) 201-3912 | |
Not Available |
Full Name | Wisconsin Psychology Associates, Llc |
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Speciality | Psychologist |
Location | 318 Margaret Ct, Burlington, Wisconsin |
Authorized Official Name and Position | Rosita Fernandez (OWNER/PSYCHOLOGIST) |
Authorized Official Contact | 8122013912 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Wisconsin Psychology Associates, Llc 318 Margaret Ct Burlington WI 53105-2330 Ph: () - | Wisconsin Psychology Associates, Llc 318 Margaret Ct Burlington WI 53105-2330 Ph: (812) 201-3912 |
NPI Number | 1639830151 |
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Provider Enumeration Date | 01/06/2022 |
Last Update Date | 02/09/2022 |
Certification Date | 02/09/2022 |
Medicare PECOS PAC ID | 7012381536 |
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Medicare Enrollment ID | O20230324001279 |
Identifier | Type | State | Issuer |
---|---|---|---|
1639830151 | NPI | - | NPPES |
300007198IN | Medicaid | IN | |
1376062851 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TC0700X | Psychologist - Clinical | (* (Not Available)) | Secondary |
103TH0100X | Psychologist - Health Service | (* (Not Available)) | Primary |
Provider Name | Rosita Fernandez |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1376062851 PECOS PAC ID: 7416221502 Enrollment ID: I20230324001341 |
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