NPIMap

Organization Active NPI

Family Therapy Center of Madison, Inc.

  • Clinical Social Worker
  • Madison, WI
National Provider Identifier
1164587150
Registry record updated Oct 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 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
Last updated
Oct 25, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2013

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

Authorized official

Name
Carol FaynikNPI 1164587366
Title
President/Treasurer
Phone
(608) 276-9191

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC0700X
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X Primary
Marriage & Family TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 106H00000X
Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0800X
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040211000028 WI Part B Supplier - Clinic/Group Practice 1850285826 Receives reassigned benefits from 19 practitioners
Practice locations: Madison, WI

National Provider Directory

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

Practitioners & affiliated clinicians

Practitioners 32

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.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382659200000",
    "number": "1164587150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 RAY O VAC DR",
            "address_2": "SUITE 220",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537112479",
            "telephone_number": "608-276-9191",
            "fax_number": "608-276-9144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 RAY O VAC DR",
            "address_2": "SUITE 220",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537112479",
            "telephone_number": "608-276-9191",
            "fax_number": "608-276-9144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY THERAPY CENTER OF MADISON, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2013-10-25",
        "status": "A",
        "authorized_official_last_name": "FAYNIK",
        "authorized_official_first_name": "CAROL",
        "authorized_official_title_or_position": "PRESIDENT/TREASURER",
        "authorized_official_telephone_number": "608-276-9191"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.