| Waisman Center Ties Clinic | |
|
122 E Olin Ave Ste 255 Madison WI 53713 | |
| (608) 265-9438 | |
| (608) 263-4681 |
| Full Name | Waisman Center Ties Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 122 E Olin Ave Ste 255, Madison, Wisconsin |
| Authorized Official Name and Position | Kenneth Mount (ASSOCIATE DEAN) |
| Authorized Official Contact | 6082634938 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Waisman Center Ties Clinic 122 E Olin Ave Ste 255 Madison WI 53713-1468 Ph: (608) 265-9438 | Waisman Center Ties Clinic 122 E Olin Ave Ste 255 Madison WI 53713 Ph: (608) 265-9438 |
| NPI Number | 1184746828 |
|---|---|
| Provider Enumeration Date | 04/04/2007 |
| Last Update Date | 06/18/2018 |
| Medicare PECOS PAC ID | 9133024888 |
|---|---|
| Medicare Enrollment ID | O20150420000868 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184746828 | NPI | - | NPPES |
| 21252100 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
| Provider Name | Steven Singer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598789331 PECOS PAC ID: 6406864545 Enrollment ID: I20060330000492 |
| Provider Name | Lauren Bern |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1184675266 PECOS PAC ID: 2860493954 Enrollment ID: I20070116000067 |
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