| Family Services Of New | |
|
1810 Appleton Rd Menasha WI 54952-1110 | |
| (920) 739-4226 | |
| (920) 739-7639 |
| Full Name | Family Services Of New |
|---|---|
| Speciality | Clinic/Center |
| Location | 1810 Appleton Rd, Menasha, Wisconsin |
| Authorized Official Name and Position | Thomas E Martin (PRESIDENT / CEO) |
| Authorized Official Contact | 9204366800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Services Of New 1810 Appleton Rd Menasha WI 54952-1110 Ph: (920) 739-4226 | Family Services Of New 1810 Appleton Rd Menasha WI 54952-1110 Ph: (920) 739-4226 |
| NPI Number | 1275525925 |
|---|---|
| Provider Enumeration Date | 08/18/2005 |
| Last Update Date | 06/04/2009 |
| Medicare PECOS PAC ID | 7214832229 |
|---|---|
| Medicare Enrollment ID | O20031203000498 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275525925 | NPI | - | NPPES |
| 42222600 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 1333 (Wisconsin) | Primary |
| Provider Name | James V Drake |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245326172 PECOS PAC ID: 9638243629 Enrollment ID: I20080808000814 |
| Provider Name | Vicky L Coppens |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437244662 PECOS PAC ID: 2567514599 Enrollment ID: I20090722000207 |
| Provider Name | Clarissa Detrie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073759577 PECOS PAC ID: 1254504541 Enrollment ID: I20111102000191 |
| Provider Name | Sarah C Thiesfeldt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811346745 PECOS PAC ID: 4587917331 Enrollment ID: I20181025001180 |
| Provider Name | Kaitlynne A Maguire |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205592128 PECOS PAC ID: 4284009838 Enrollment ID: I20230412001758 |
| Provider Name | Phoenix A Van Laanen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609354166 PECOS PAC ID: 9032563275 Enrollment ID: I20230921003519 |
| Provider Name | Libbi Burke |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1861011363 PECOS PAC ID: 8921450727 Enrollment ID: I20240216004332 |
| Provider Name | Sophia M Hueter |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1316594021 PECOS PAC ID: 0244681070 Enrollment ID: I20240228004085 |
| Provider Name | Chelsea S Mcguire |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518346931 PECOS PAC ID: 5991140709 Enrollment ID: I20240304001041 |
| Provider Name | James K Dercks |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1134586779 PECOS PAC ID: 4880045640 Enrollment ID: I20240305000192 |
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