Individual provider Active NPI

Maureen R Goldblatt, LPC, CSAC

  • Professional Counselor
  • Brookfield, WI
National Provider Identifier
1275791345
Registry record updated Jan 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
3162-125 Issued in WI
Practice address
16535 W Bluemound Rd Ste 200
Brookfield, WI 53005-5906
Phone
(262) 789-1191
Fax
(262) 821-6180
NPI assigned
May 27, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 11371-132 WI
Professional Counselor 101YP2500X E0700276 OH
Professional Counselor 101YP2500X 3162-125 WI Primary

Addresses

Primary practice location

16535 W Bluemound Rd Ste 200
Brookfield, WI 53005-5906

Mailing address

16535 W Bluemound Rd Ste 200
Brookfield, WI 53005-5906
Phone (262) 789-1191

Other identifiers 1

IdentifierTypeStateIssuer
40909800MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240126001109 WI Practitioner - Mental Health Counselor 2264885128 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11371-132WIMDAddiction (Substance Use Disorder) Counselor
E0700276OHMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Cornerstone Counseling Services, Inc Addiction (Substance Use Disorder) CurrentSince Jan 1, 2024 Accepting new patients

Locations

16535 W Bluemound Rd
Ste 200
Brookfield, WI 53005
Phone (262) 789-0909

10850 W Park Pl
Ste 100
Milwaukee, WI 53224
Phone (414) 361-4100

111 E Wisconsin Ave
Ste 1500
Milwaukee, WI 53202
Phone (253) 372-8662

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.maureengoldblatt@149809.advancedmd-direct.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1211846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736899200000",
    "number": "1275791345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16535 W BLUEMOUND RD STE 200",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530055906",
            "telephone_number": "262-789-1191",
            "fax_number": "262-821-6180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16535 W BLUEMOUND RD STE 200",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530055906",
            "telephone_number": "262-789-1191",
            "fax_number": "262-821-6180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDBLATT",
        "first_name": "MAUREEN",
        "middle_name": "R",
        "name_prefix": "Ms.",
        "credential": "LPC,  CSAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-27",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "11371-132",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E0700276",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "3162-125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40909800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookfield, WI

Sources for this page

Verify at the official NPI Registry.