NPIMap

Organization Active NPI

Riverwalk Psychotherapy Associates, LLC

  • General Practice Physician
  • Milwaukee, WI
National Provider Identifier
1073687349
Registry record updated Jun 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
RIVERWALK PSYCHOTHERAPY ASSOCIATES, LLC
Practice address
1110 N. Old World Third St.
Suite 401
Milwaukee, WI 53203
Phone
(414) 224-0800
Fax
(414) 224-0883
NPI assigned
Nov 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Serena Courtney Clardie
Title
Partner/Psychotherapist
Phone
(414) 224-0800

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

1110 N. Old World Third St.
Suite 401
Milwaukee, WI 53203

Mailing address

1110 N. Old World Third St.
Suite 401
Milwaukee, WI 53203
Phone (608) 423-3960

Other identifiers 1

IdentifierTypeStateIssuer
42184700MedicaidWI

Other names 1

  • Midwest Center for Human Services Former legal business name

National Provider Directory

National Provider Directory

Locations

817 N Marshall St
Milwaukee, WI 53202
Phone (414) 224-0800

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402358400000",
    "number": "1073687349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 N. OLD WORLD THIRD ST.",
            "address_2": "SUITE 401",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53203",
            "telephone_number": "608-423-3960",
            "fax_number": "608-423-7166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 N. OLD WORLD THIRD ST.",
            "address_2": "SUITE 401",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53203",
            "telephone_number": "414-224-0800",
            "fax_number": "414-224-0883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERWALK PSYCHOTHERAPY ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2014-06-10",
        "status": "A",
        "authorized_official_last_name": "CLARDIE",
        "authorized_official_first_name": "SERENA",
        "authorized_official_middle_name": "COURTNEY",
        "authorized_official_title_or_position": "PARTNER/PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "414-224-0800"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42184700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midwest Center for Human Services",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.