Provider Demographics
NPI:1376272500
Name:PROVIDENCE PSYCHIATRIC SERVICES S C
Entity Type:Organization
Organization Name:PROVIDENCE PSYCHIATRIC SERVICES S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PINTARRO
Authorized Official - Suffix:
Authorized Official - Credentials:APNP
Authorized Official - Phone:414-239-3172
Mailing Address - Street 1:333 BISHOPS WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-6209
Mailing Address - Country:US
Mailing Address - Phone:414-239-3172
Mailing Address - Fax:
Practice Address - Street 1:333 BISHOPS WAY STE 102
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-6209
Practice Address - Country:US
Practice Address - Phone:414-239-3172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-04
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty