Provider Demographics
NPI:1609997683
Name:CHILD ADOLESCENT FAMILY MARRIAGE THERAPY ASSOCIATES
Entity Type:Organization
Organization Name:CHILD ADOLESCENT FAMILY MARRIAGE THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LMFT
Authorized Official - Phone:414-272-5005
Mailing Address - Street 1:230 W WELLS ST
Mailing Address - Street 2:SUITE 630
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203-1866
Mailing Address - Country:US
Mailing Address - Phone:414-272-5005
Mailing Address - Fax:414-272-3760
Practice Address - Street 1:230 W WELLS ST
Practice Address - Street 2:SUITE 630
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53203-1866
Practice Address - Country:US
Practice Address - Phone:414-272-5005
Practice Address - Fax:414-272-3760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1934-1231041C0700X
WI3168-1231041C0700X
WI249-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42186800Medicaid
WI84443Medicare PIN