Provider Demographics
NPI:1598178170
Name:RIVERWALK PSYCHOTHERAPY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:RIVERWALK PSYCHOTHERAPY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SERENA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARDIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-224-0800
Mailing Address - Street 1:1110 N OLD WORLD 3RD ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203-1100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1110 N OLD WORLD 3RD ST
Practice Address - Street 2:SUITE 401
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53203-1100
Practice Address - Country:US
Practice Address - Phone:414-224-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center