Healthcare Provider Details

I. General information

NPI: 1164256038
Provider Name (Legal Business Name): TOSA PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2024
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9205 W CENTER ST STE 203
MILWAUKEE WI
53222-4548
US

IV. Provider business mailing address

9205 W CENTER ST STE 203
MILWAUKEE WI
53222-4548
US

V. Phone/Fax

Practice location:
  • Phone: 414-522-7899
  • Fax:
Mailing address:
  • Phone: 414-377-4787
  • Fax: 866-643-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. DOMENICK TIRABASSI IV
Title or Position: OWNER
Credential: PSYD
Phone: 414-377-4787