Ajeng Juwita Puspitasari, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

5074-057 Issued in WI

Practice address

2153 N Dr Martin Luther King Dr Ste 2500
Milwaukee, WI 53212-3101

Phone

(414) 955-7276

Fax

(414) 955-0146

NPI assigned

Sep 18, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• North Shore Center LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Mequon, WI
  • NPI 1780755389
  NPD (past)

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

{
    "created_epoch": "1505692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787184000000",
    "number": "1346769759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2153 N DR MARTIN LUTHER KING DR STE 2500",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532123101",
            "telephone_number": "414-955-7276",
            "fax_number": "414-955-0146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2153 N DR MARTIN LUTHER KING DR STE 2500",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532123101",
            "telephone_number": "414-955-7276",
            "fax_number": "414-955-0146"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 1st St SW",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "MN",
            "postal_code": "55905",
            "country_code": "US",
            "telephone_number": "507-284-2511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PUSPITASARI",
        "first_name": "AJENG",
        "middle_name": "JUWITA",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-18",
        "last_updated": "2026-08-20",
        "certification_date": "2026-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "5074-057",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP6254",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1346769759",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Puru Health Care LLC
• Stephanie Puryear, OTR/L
• Jamie Lee Puschnig, APNP
• Mark Pushkash, PH.D.
• Patricia Marie Puskarich, RD
• Megan Sue Puthoff, FNP-C
• Julie A Putman, RN, MSN
• Michael Putman, M.D.
• Anne Putra, L.AC.
• Tracy Mae Puttre, RN, APNP, AGPCNP-C

• Clinical Psychologist in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Clinical Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.