Provider Demographics
NPI:1376934976
Name:PIVA, YONAT (LMFT)
Entity Type:Individual
Prefix:
First Name:YONAT
Middle Name:
Last Name:PIVA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:YONAT
Other - Middle Name:
Other - Last Name:MAYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE # MS 958
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-7615
Mailing Address - Fax:
Practice Address - Street 1:725 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-4106
Practice Address - Country:US
Practice Address - Phone:715-387-2729
Practice Address - Fax:715-387-4526
Is Sole Proprietor?:No
Enumeration Date:2015-02-18
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68108106H00000X
WI1301106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1376934976Medicaid