Lake Geneva Psychology, Inc.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

LAKE GENEVA PSYCHOLOGY, INC.

Practice address

630 Kenosha St
Walworth, WI 53184-9505

Phone

(305) 989-9030

NPI assigned

Apr 30, 2020

Last updated

Apr 30, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Amy Sosa, PSY.D., CEDSNPI 1033584404

Title

Director/Owner

Phone

(305) 989-9030

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Amy Sosa, PSY.D.

  • Clinical Psychologist
  • Janesville, WI
  • NPI 1033584404
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1588204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588204800000",
    "number": "1972124980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N1330 OVERLAND LN",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531477302",
            "telephone_number": "305-989-9030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 KENOSHA ST",
            "city": "WALWORTH",
            "state": "WI",
            "postal_code": "531849505",
            "telephone_number": "305-989-9030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE GENEVA PSYCHOLOGY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-30",
        "last_updated": "2020-04-30",
        "certification_date": "2020-04-30",
        "status": "A",
        "authorized_official_last_name": "SOSA",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "DIRECTOR/OWNER",
        "authorized_official_telephone_number": "305-989-9030",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D., CEDS"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Golembiewski, LPC
• Megan R Hopp, NP
• Dale Gary Jacobson, MD
• Victoria Ann Knull, RN
• Bridget Grace Labus, DC
• McCullough Pharmacy Inc (McCulloughs Prescription and Gifts)
• Michael C. Nice, D.C.
• Catie Fern Pontel, PTA
• Powerback Rehabilitation LLC (Powerback Rehabilitation)
• Daniel William Rankin

• Clinical Psychologist in Walworth, WI
• Providers in Walworth, WI by specialty
• Clinical Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.