Provider Demographics
NPI:1104384387
Name:CENTER FOR EMOTIONAL WELLNESS LLC.
Entity Type:Organization
Organization Name:CENTER FOR EMOTIONAL WELLNESS LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHIRAG
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-235-3311
Mailing Address - Street 1:W156N8327 PILGRIM RD STE 301
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-3776
Mailing Address - Country:US
Mailing Address - Phone:262-235-3311
Mailing Address - Fax:262-235-3310
Practice Address - Street 1:W156N8327 PILGRIM RD STE 301
Practice Address - Street 2:
Practice Address - City:MENOMONEE FLS
Practice Address - State:WI
Practice Address - Zip Code:53051-3776
Practice Address - Country:US
Practice Address - Phone:262-235-3311
Practice Address - Fax:262-235-3310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1033305941OtherNPI NUMBER