Provider Demographics
NPI:1033215025
Name:FAMILY CARE PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:FAMILY CARE PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:LUECK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:414-771-5002
Mailing Address - Street 1:2500 N MAYFAIR RD STE 560
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1415
Mailing Address - Country:US
Mailing Address - Phone:414-771-5002
Mailing Address - Fax:414-771-2928
Practice Address - Street 1:2500 N MAYFAIR RD STE 560
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1415
Practice Address - Country:US
Practice Address - Phone:414-771-5002
Practice Address - Fax:414-771-2928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIHFS 61.91103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI84470Medicare ID - Type Unspecified