Provider Demographics
NPI:1659467538
Name:LINDA I GARRITY
Entity Type:Organization
Organization Name:LINDA I GARRITY
Other - Org Name:CENTER FOR COUNSELING & PSYCHOLOGICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:I
Authorized Official - Last Name:GARRITY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:608-255-0100
Mailing Address - Street 1:110 E MAIN ST
Mailing Address - Street 2:SUITE 702
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3395
Mailing Address - Country:US
Mailing Address - Phone:608-255-0100
Mailing Address - Fax:608-251-2404
Practice Address - Street 1:110 E MAIN ST
Practice Address - Street 2:SUITE 702
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-3395
Practice Address - Country:US
Practice Address - Phone:608-255-0100
Practice Address - Fax:608-251-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2007-11-07
Deactivation Date:2007-07-13
Deactivation Code:
Reactivation Date:2007-11-07
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42143800Medicaid
WI42143800Medicaid