Eugene F Braaksma, PHD
Individual provider Active NPI Clinical Psychologist · Milwaukee, WI
NPI 1669656245 · NPPES record last updated Mar 9, 2020
Key facts
- NPI
- 1669656245
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 1236 (WI)
- Practice address
- 930 W Historic Mitchell St
Milwaukee, WI 53204-3533 - Phone
- (414) 383-9526
- Fax
- (414) 671-6606
- NPI assigned
- Dec 19, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040330000322 | WI | Practitioner - Clinical Psychologist | 7214829597 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1236-057 | WI | MD | Mental Health Counselor |
| 1236 | WI | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gerald L. Ignace Indian Health Center, Inc. | Current |
Accepting new patients | |
| Behavioral Solutions, Inc. | Past |
Accepting new patients |
Locations
930 W Mitchell St
Milwaukee, WI 53204
Phone (414) 383-9526
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 1236-057 | WI | |
| Clinical Psychologist | 103TC0700X | 1236 | WI | Yes |
Addresses
Primary practice location
930 W Historic Mitchell St
Milwaukee, WI 53204-3533
Mailing address
930 W Historic Mitchell St
Milwaukee, WI 53204-3533
Phone (414) 383-9526
Other providers in Milwaukee, WI
- Madeleine Boyle
- Jessica Boyles
- Natalie Bozikowski
- Mary Bozsik
- Kevin Bozymski
- Kylie Lynn Braam
- Christopher Brabant
- Nicholas Bracciano
- Lucia Elizabeth Bracco
- Candice Brace
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 Mar 9, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.