| Gorecki Psychological Services Llc | |
|
19275 W Capitol Dr Ste 200 Brookfield WI 53045-2734 | |
| (262) 546-7478 | |
| (262) 373-0362 |
| Full Name | Gorecki Psychological Services Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 19275 W Capitol Dr Ste 200, Brookfield, Wisconsin |
| Authorized Official Name and Position | Kim Marie Gorecki (OWNER/CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 2625467478 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gorecki Psychological Services Llc 19275 W Capitol Dr Ste 200 Brookfield WI 53045-2734 Ph: (262) 546-7478 | Gorecki Psychological Services Llc 19275 W Capitol Dr Ste 200 Brookfield WI 53045-2734 Ph: (262) 546-7478 |
| NPI Number | 1083170732 |
|---|---|
| Provider Enumeration Date | 02/19/2019 |
| Last Update Date | 02/19/2019 |
| Medicare PECOS PAC ID | 3173866605 |
|---|---|
| Medicare Enrollment ID | O20190523001699 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083170732 | NPI | - | NPPES |
| 1649361775 | Other | WI | NPI |
| 2810-057 | Other | WI | CP LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Kim M Gorecki |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1649361775 PECOS PAC ID: 8426062142 Enrollment ID: I20060202000277 |
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