Provider Demographics
NPI:1356061485
Name:WHOLE PATH PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:WHOLE PATH PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:414-501-3161
Mailing Address - Street 1:3758 S IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:ST FRANCIS
Mailing Address - State:WI
Mailing Address - Zip Code:53235-4163
Mailing Address - Country:US
Mailing Address - Phone:414-501-3161
Mailing Address - Fax:414-246-4238
Practice Address - Street 1:1037 W MCKINLEY AVE STE 366
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-2530
Practice Address - Country:US
Practice Address - Phone:414-501-3161
Practice Address - Fax:414-246-4238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-30
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty