Provider Demographics
NPI:1407918329
Name:MARIFROG, RAINBOW ANDREA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:RAINBOW
Middle Name:ANDREA
Last Name:MARIFROG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 INTERNATIONAL LN STE 202
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3135
Mailing Address - Country:US
Mailing Address - Phone:608-520-6207
Mailing Address - Fax:608-646-7531
Practice Address - Street 1:2917 INTERNATIONAL LN STE 202
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3135
Practice Address - Country:US
Practice Address - Phone:608-520-6207
Practice Address - Fax:608-646-7531
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI124-919106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist