Healthcare Provider Details

I. General information

NPI: 1194880286
Provider Name (Legal Business Name): PATRICK J TRIGGIANO PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12760 W NORTH AVE BLDG A
BROOKFIELD WI
53005-4628
US

IV. Provider business mailing address

12760 W NORTH AVE BLDG A
BROOKFIELD WI
53005-4628
US

V. Phone/Fax

Practice location:
  • Phone: 262-439-5500
  • Fax: 262-439-5221
Mailing address:
  • Phone: 262-439-5500
  • Fax: 262-439-5221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2752-57
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301013947
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: