Healthcare Provider Details

I. General information

NPI: 1659467538
Provider Name (Legal Business Name): LINDA I GARRITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date: 07/13/2007
Reactivation Date: 11/07/2007

III. Provider practice location address

110 E MAIN ST SUITE 702
MADISON WI
53703-3395
US

IV. Provider business mailing address

110 E MAIN ST SUITE 702
MADISON WI
53703-3395
US

V. Phone/Fax

Practice location:
  • Phone: 608-255-0100
  • Fax: 608-251-2400
Mailing address:
  • Phone: 608-255-0100
  • Fax: 608-251-2404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. LINDA I GARRITY
Title or Position: COORDINATOR
Credential: PHD
Phone: 608-255-0100