Provider Demographics
NPI:1265512586
Name:LAKE MONONA PSYCHOTHERAPY & RECOVERY CENTER
Entity type:Organization
Organization Name:LAKE MONONA PSYCHOTHERAPY & RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:J
Authorized Official - Last Name:CREMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, RADCI
Authorized Official - Phone:608-256-5030
Mailing Address - Street 1:900 JOHN NOLEN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-1465
Mailing Address - Country:US
Mailing Address - Phone:608-256-5030
Mailing Address - Fax:608-256-5038
Practice Address - Street 1:900 JOHN NOLEN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-1465
Practice Address - Country:US
Practice Address - Phone:608-256-5030
Practice Address - Fax:608-256-5038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42147700Medicaid