Provider Demographics
NPI:1619489135
Name:STREICHER-BREMER PSYCHOTHERAPY SC
Entity Type:Organization
Organization Name:STREICHER-BREMER PSYCHOTHERAPY SC
Other - Org Name:JODI STREICHER-BREMER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:STREICHER-BREMER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:608-255-9330
Mailing Address - Street 1:1619 MONROE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2063
Mailing Address - Country:US
Mailing Address - Phone:608-255-9330
Mailing Address - Fax:
Practice Address - Street 1:1619 MONROE ST STE 2
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2063
Practice Address - Country:US
Practice Address - Phone:608-255-9330
Practice Address - Fax:608-255-7810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2642-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI002884027OtherMEDICARE
WI39153800Medicaid