Provider Demographics
NPI:1245245794
Name:A NEW DAY PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:A NEW DAY PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BONITA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:DEBBAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:262-567-7900
Mailing Address - Street 1:970 S SILVER LAKE ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-3802
Mailing Address - Country:US
Mailing Address - Phone:262-567-7900
Mailing Address - Fax:262-567-7908
Practice Address - Street 1:970 S SILVER LAKE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-3802
Practice Address - Country:US
Practice Address - Phone:262-567-7900
Practice Address - Fax:262-567-7908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2324-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43550000Medicaid