Individual provider Active NPI

Laura Tooran Mirhoseini, PSY D

  • Clinical Psychologist
  • New Berlin, WI
National Provider Identifier
1487646436
Registry record updated Jul 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
2509-57 Issued in WI
Practice address
14555 W National Ave
New Berlin, WI 53151-4494
Phone
(414) 293-9606
NPI assigned
Aug 16, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 2509-57 WI Primary

Addresses

Primary practice location

14555 W National Ave
New Berlin, WI 53151-4494

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (800) 326-2250

Other practice location 1

190 Gardner Ave Ste 3
Burlington, WI 53105-2160
Phone (262) 763-7766

Other identifiers 1

IdentifierTypeStateIssuer
39145800MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address lmirhoseini103056@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

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
I20140109000511 WI Practitioner - Clinical Psychologist 4587892948

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3301 W Forest Home Ave
Milwaukee, WI 53215-2843

S74W16775 Janesville Rd
Muskego, WI 53150

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2509-57WIMDClinical Psychologist
2509WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. Current Accepting new patients
Aurora Medical Group, Inc. CurrentSince Jan 13, 2014 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Jan 13, 2014 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

190 Gardner Ave
Ste 3
Burlington, WI 53105
Phone (262) 763-7766

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

S74W16775 Janesville Rd
Muskego, WI 53150
Phone (414) 422-4747

620 15th Ave
Union Grove, WI 53182
Phone (262) 878-1211

Interoperability endpoints

  • Direct secure messaging: lmirhoseini103056@direct.myadvocateaurora.org

Organizations & group practices 4

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": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752105600000",
    "number": "1487646436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044",
            "telephone_number": "800-326-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14555 W NATIONAL AVE",
            "city": "NEW BERLIN",
            "state": "WI",
            "postal_code": "531514494",
            "telephone_number": "414-293-9606"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "190 Gardner Ave Ste 3",
            "address_purpose": "LOCATION",
            "city": "Burlington",
            "state": "WI",
            "postal_code": "531052160",
            "country_code": "US",
            "telephone_number": "262-763-7766",
            "fax_number": "262-763-9326",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIRHOSEINI",
        "first_name": "LAURA",
        "middle_name": "TOORAN",
        "credential": "PSY D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-16",
        "last_updated": "2025-07-10",
        "certification_date": "2025-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "2509-57",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39145800",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lmirhoseini103056@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "190 Gardner Ave Ste 3",
            "city": "Burlington",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531052160",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "190 Gardner Ave Ste 3",
            "city": "Burlington",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531052160",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in New Berlin, WI

Sources for this page

Verify at the official NPI Registry.