Family Therapy Center of Madison, Inc.
Organization Active NPI Clinical Social Worker · Madison, WI
NPI 1164587150 · NPPES record last updated Oct 25, 2013
Key facts
- NPI
- 1164587150
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Social Worker 1041C0700X
- Legal business name
- FAMILY THERAPY CENTER OF MADISON, INC.
- Practice address
- 700 Ray O Vac Dr
Suite 220
Madison, WI 53711-2479 - Phone
- (608) 276-9191
- Fax
- (608) 276-9144
- NPI assigned
- Dec 27, 2006
- Organization subpart
- No
Authorized official
- Name
- Carol Faynik
- Title
- President/Treasurer
- Phone
- (608) 276-9191
Practitioners 31
-
Jean S. Bae, M.D.
-
Melinda M. Bailey, PHD
-
Aimee Harris, LPC
-
Amy Kucin, MS
-
Marcia Marie Leaser, SAC
-
Sabrina Carol Loomis, LCSW
-
Danielle Ogno, MS
-
Matthew R Peverill, PHD
-
Sarah L Splinter, LCSW, MSW
-
Tricia Ann Vandenakker, LCSW, MSW
-
Maureen White, PH.D.
-
Mary E Batson, LPC
-
Celia L. Huerta, LPC
-
Kirsten Miller, MSW, LCSW
-
Stephanie Diane Mock, MSW
-
Anne S. Beal, MSSW
-
Amanda Case, MSSW
-
Judith A Utevsky, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040211000028 | WI | Part B Supplier - Clinic/Group Practice | 1850285826 |
Receives reassigned benefits from 19 practitioners Practice locations: Madison, WI |
National Provider Directory
Locations
10 E Doty St
Ste 445
Madison, WI 53703
Phone (608) 276-9191
700 Ray O Vac Dr
Ste 220
Madison, WI 53711
Phone (608) 276-9191
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist |
103TC0700X | |||
| Clinical Social Worker |
1041C0700X | Yes | ||
| Marriage & Family Therapist |
106H00000X | |||
| Psychiatry Physician |
2084P0800X | |||
| Psychiatric/Mental Health Nurse Practitioner |
363LP0808X |
Addresses
Primary practice location
700 Ray O Vac Dr
Suite 220
Madison, WI 53711-2479
Mailing address
700 Ray O Vac Dr
Suite 220
Madison, WI 53711-2479
Phone (608) 276-9191
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42111900 | Medicaid | WI |
Other providers in Madison, WI
- Familia Dental Madison East LLC
- Familia Dental Madison West LLC
- Family Chiropractic Clinic Inc
- Family Service Madison Inc
- Family Support and Resource Center
- Family Works Programs, Inc.
- Familypath Autism Services, LLC
- Maryam Leila Famouri
- Inga Hope Fane
- Joyce Fang
All providers in Madison, WI · Clinical Social Worker in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 25, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.