Divya Bhagavatula
Individual provider Active NPI Clinical Psychologist · Milwaukee, WI
NPI 1497130371 · NPPES record last updated May 1, 2023
Key facts
- NPI
- 1497130371
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 5062 (WI)
- Practice address
- 1155 N Mayfair Rd
Milwaukee, WI 53226-3462 - Phone
- (414) 955-8900
- Fax
- (414) 955-6285
- NPI assigned
- Jul 21, 2015
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5062 | WI | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 5062 | WI | Yes |
Addresses
Primary practice location
1155 N Mayfair Rd
Milwaukee, WI 53226-3462
Mailing address
1155 N Mayfair Rd
Milwaukee, WI 53226-3462
Phone (414) 955-8900
Other providers in Milwaukee, WI
- Beyond Wellness PLLC
- Rebecca Davina Beznowski
- BH Legacy in-Home Care, LLC
- Gary Bhagat
- Subramony Bhagavatheeswaran
- Ram Bhala
- Amaal Bhaloo
- Sanjay Bhandari
- Yogendra Bharat
- A. G. Bharatkumar
All providers in Milwaukee, WI · Clinical Psychologist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 1, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.