NPIMap

Organization Active NPI

Racine Psychological Services, Inc.

  • Adult Mental Health Clinic/Center
  • Racine, WI
National Provider Identifier
1275586323
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
2220 Issued in WI
Legal business name
RACINE PSYCHOLOGICAL SERVICES, INC.
Practice address
840 Lake Ave
Suite 101
Racine, WI 53403-1566
Phone
(262) 634-8688
Fax
(262) 634-7547
NPI assigned
May 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Mary Jane Whitmore, LCSW, CSAC
Title
Director
Phone
(262) 634-8688

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X 2220 WI Primary

Addresses

Primary practice location

840 Lake Ave
Suite 101
Racine, WI 53403-1566

Mailing address

840 Lake Ave
Suite 101
Racine, WI 53403-1566
Phone (262) 634-8688

Other identifiers 1

IdentifierTypeStateIssuer
42216900MedicaidWI

National Provider Directory

National Provider Directory

Locations

209 N Main St
Burlington, WI 53105
Phone (262) 634-8688

840 Lake Ave
Ste 101
Racine, WI 53403
Phone (262) 634-8688

Practitioners & affiliated clinicians

Practitioners 10

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": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1275586323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 LAKE AVE",
            "address_2": "SUITE 101",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534031566",
            "telephone_number": "262-634-8688",
            "fax_number": "262-634-7547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 LAKE AVE",
            "address_2": "SUITE 101",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534031566",
            "telephone_number": "262-634-8688",
            "fax_number": "262-634-7547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RACINE PSYCHOLOGICAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "WHITMORE",
        "authorized_official_first_name": "MARY JANE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "262-634-8688",
        "authorized_official_credential": "LCSW, CSAC"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "WI",
            "license": "2220",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42216900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Racine, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.