NPIMap

Lisa (Pema) Antoniotti

Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Madison, WI

NPI 1639768989 · NPPES record last updated Jan 12, 2021

Key facts

NPI
1639768989
Entity type
Individual (NPI type 1)
Primary specialty
Addiction (Substance Use Disorder) Counselor 101YA0400X
License
18401 (WI)
Practice address
49 Kessel CT
Madison, WI 53711-6200
Phone
(608) 280-2700
NPI assigned
Jan 12, 2021
Sex
Female
Sole proprietor
No

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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
18401WIMDAddiction (Substance Use Disorder) Counselor
4103WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Journey Mental Health Center, Inc. Current
since Jan 17, 2021		 Accepting new patients

Locations

25 Kessel Ct
Ste 105
Madison, WI 53711
Phone (608) 280-2636

49 Kessel Ct
Madison, WI 53711
Phone (608) 280-2510

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 4103 WI
Addiction (Substance Use Disorder) Counselor 101YA0400X 18401 WI Yes

Addresses

Primary practice location

49 Kessel CT
Madison, WI 53711-6200

Mailing address

25 Kessel CT Ste 105
Madison, WI 53711-6227
Phone (608) 280-2700

Other providers in Madison, WI

All providers in Madison, WI · Addiction (Substance Use Disorder) Counselor in Wisconsin

Sources for this page

Verify at the official NPI Registry.