Provider Demographics
NPI:1063643617
Name:BARTOSZEWICZ, PETER JOSEPH
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JOSEPH
Last Name:BARTOSZEWICZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3734 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-3153
Mailing Address - Country:US
Mailing Address - Phone:414-343-3549
Mailing Address - Fax:414-344-6111
Practice Address - Street 1:3734 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-3153
Practice Address - Country:US
Practice Address - Phone:414-343-3549
Practice Address - Fax:414-344-6111
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4206-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health