Provider Demographics
NPI:1790230589
Name:LOIS PULVERMACHER AND ASSOCIATES LLC
Entity Type:Organization
Organization Name:LOIS PULVERMACHER AND ASSOCIATES LLC
Other - Org Name:CROSSING THE BRIDGES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:PULVERMACHER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:920-712-4526
Mailing Address - Street 1:101 PRIMROSE LN
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-6882
Mailing Address - Country:US
Mailing Address - Phone:920-712-4526
Mailing Address - Fax:800-469-0235
Practice Address - Street 1:840 CHALLENGER DR STE 130
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-8351
Practice Address - Country:US
Practice Address - Phone:920-712-4526
Practice Address - Fax:800-469-0235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WILCSW 7302-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40918400Medicaid