NPIMap

Organization Active NPI

Pediatric Psychology Associates LLC

Doing business as Autism Behavioral Network

  • Clinical Psychologist
  • Wauwatosa, WI
National Provider Identifier
1124193065
Registry record updated Sep 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
613 057 Issued in WI
Legal business name
PEDIATRIC PSYCHOLOGY ASSOCIATES LLC
Doing business as
Autism Behavioral Network
Practice address
3636 N 124TH St
3Rd Floor
Wauwatosa, WI 53222-2125
Phone
(414) 476-9755
Fax
(414) 476-3413
NPI assigned
Nov 22, 2006
Last updated
Sep 27, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2016

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

Authorized official

Name
Dr. Tracy R Pritzl, PSYD, BCBA-DNPI 1427243369
Title
Director Owner
Phone
(414) 476-9755

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 613 057 WI Primary

Addresses

Primary practice location

3636 N 124TH St
3Rd Floor
Wauwatosa, WI 53222-2125

Mailing address

3636 N 124TH St
3Rd Floor
Wauwatosa, WI 53222-2125
Phone (414) 476-9755

Other names 1

  • Autism Behavioral Network Doing business as

National Provider Directory

National Provider Directory

Locations

3636 N 124th St
Fl 3
Wauwatosa, WI 53222
Phone (414) 476-9755

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474934400000",
    "number": "1124193065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3636 N 124TH ST",
            "address_2": "3RD FLOOR",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532222125",
            "telephone_number": "414-476-9755",
            "fax_number": "414-476-3413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3636 N 124TH ST",
            "address_2": "3RD FLOOR",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532222125",
            "telephone_number": "414-476-9755",
            "fax_number": "414-476-3413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC PSYCHOLOGY ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-22",
        "last_updated": "2016-09-27",
        "status": "A",
        "authorized_official_last_name": "PRITZL",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DIRECTOR OWNER",
        "authorized_official_telephone_number": "414-476-9755",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD, BCBA-D"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "613 057",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Autism Behavioral Network",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wauwatosa, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2016; 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.