Provider Demographics
NPI:1952890618
Name:RIVERBIRCH THERAPY, LLC
Entity Type:Organization
Organization Name:RIVERBIRCH THERAPY, LLC
Other - Org Name:RIVERBIRCH THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CAITLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSMAN BLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:608-512-0461
Mailing Address - Street 1:3606 RICHARD ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-2325
Mailing Address - Country:US
Mailing Address - Phone:763-639-9769
Mailing Address - Fax:
Practice Address - Street 1:2961 YARMOUTH GREENWAY DR STE B
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-5809
Practice Address - Country:US
Practice Address - Phone:608-512-0461
Practice Address - Fax:608-298-3288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6129-125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI196276587OtherNPI