NPIMap

Organization Active NPI

Child & Adolescent Psychiatry Consulting LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Marshfield, WI
National Provider Identifier
1619225232
Registry record updated Dec 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
CHILD & ADOLESCENT PSYCHIATRY CONSULTING LLC
Practice address
2001 S Central Ave Ste a
Marshfield, WI 54449-4973
Phone
(715) 384-2818
Fax
(715) 384-2724
NPI assigned
Aug 29, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2020

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

Authorized official

Name
Genessa L AntoniewiczNPI 1073063442
Title
Clinical Director
Phone
(612) 327-7015

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary

Addresses

Primary practice location

2001 S Central Ave Ste a
Marshfield, WI 54449-4973

Mailing address

2001 S Central Ave Ste a
Marshfield, WI 54449-4973
Phone (715) 384-2818

Other names 1

  • Empower Mental Health Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140304000795 WI Part B Supplier - Clinic/Group Practice 8022248483 Receives reassigned benefits from 3 practitioners
Practice locations: Marshfield, WI

National Provider Directory

National Provider Directory
Tax ID family
Behrend Psychology Consultants2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2001 S Central Ave
Ste A
Marshfield, WI 54449
Phone (715) 305-8689

Practitioners & affiliated clinicians

Practitioners 12

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": "1346198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608595200000",
    "number": "1619225232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 S CENTRAL AVE STE A",
            "city": "MARSHFIELD",
            "state": "WI",
            "postal_code": "544494973",
            "telephone_number": "715-384-2818",
            "fax_number": "715-384-2724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 S CENTRAL AVE STE A",
            "city": "MARSHFIELD",
            "state": "WI",
            "postal_code": "544494973",
            "telephone_number": "715-384-2818",
            "fax_number": "715-384-2724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILD & ADOLESCENT PSYCHIATRY CONSULTING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-29",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A",
        "authorized_official_last_name": "ANTONIEWICZ",
        "authorized_official_first_name": "GENESSA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "612-327-7015"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Empower Mental Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marshfield, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.