Provider Demographics
NPI:1841490364
Name:ACADEMIC & FAMILY SERVICES, LLC
Entity type:Organization
Organization Name:ACADEMIC & FAMILY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:262-783-7778
Mailing Address - Street 1:9120 W HAMPTON AVE
Mailing Address - Street 2:SUITE 119
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-4960
Mailing Address - Country:US
Mailing Address - Phone:262-783-7778
Mailing Address - Fax:414-464-9510
Practice Address - Street 1:9120 W HAMPTON AVE
Practice Address - Street 2:SUITE 119
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-4960
Practice Address - Country:US
Practice Address - Phone:262-783-7778
Practice Address - Fax:414-464-9510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI745-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39015500Medicaid