Provider Demographics
NPI:1760115653
Name:MADISON PSYCHOTHERAPY AND WELLNESS LLC
Entity Type:Organization
Organization Name:MADISON PSYCHOTHERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER /THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:920-397-0010
Mailing Address - Street 1:100 RIVER PL STE 260
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-4043
Mailing Address - Country:US
Mailing Address - Phone:920-397-0010
Mailing Address - Fax:
Practice Address - Street 1:100 RIVER PL STE 260
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-4043
Practice Address - Country:US
Practice Address - Phone:920-397-0010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100014628Medicaid