Healthcare Provider Details

I. General information

NPI: 1578867107
Provider Name (Legal Business Name): CYNTHIA A NOFFSINGER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13500 W CAPITOL DR SUITE 104
BROOKFIELD WI
53005-2444
US

IV. Provider business mailing address

13500 W CAPITOL DR SUITE 104
BROOKFIELD WI
53005-2444
US

V. Phone/Fax

Practice location:
  • Phone: 262-781-1976
  • Fax: 262-781-1997
Mailing address:
  • Phone: 262-781-1976
  • Fax: 262-781-1997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number1861-123
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number1861-123
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number1861-123
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number1861-123
License Number StateWI

VIII. Authorized Official

Name: CYNTHIA A NOFFSINGER
Title or Position: PSYCHOTHERAPIST
Credential: MSW, LCSW
Phone: 262-781-1976