Provider Demographics
NPI:1376013516
Name:MULTICULTURAL TRAUMA AND ADDICTION TREATMENT CENTER OF WISCONSIN
Entity Type:Organization
Organization Name:MULTICULTURAL TRAUMA AND ADDICTION TREATMENT CENTER OF WISCONSIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PH.D / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMARANTE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:973-876-3663
Mailing Address - Street 1:2222 N MAYFAIR RD STE 120
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2262
Mailing Address - Country:US
Mailing Address - Phone:414-939-9390
Mailing Address - Fax:414-939-9383
Practice Address - Street 1:2222 N MAYFAIR RD STE 120
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2262
Practice Address - Country:US
Practice Address - Phone:414-939-9390
Practice Address - Fax:414-939-9383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty