Healthcare Provider Details

I. General information

NPI: 1942215421
Provider Name (Legal Business Name): MORESCO-GONIU PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7733 W BURLEIGH ST
MILWAUKEE WI
53222-5003
US

IV. Provider business mailing address

N33W23374 GREENBRIAR CT
PEWAUKEE WI
53072-5721
US

V. Phone/Fax

Practice location:
  • Phone: 262-347-8848
  • Fax:
Mailing address:
  • Phone: 262-347-8848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1151-057
License Number StateWI

VIII. Authorized Official

Name: CAROL LYNN MORESCO-GONIU
Title or Position: OWNER/CLINIC DIRECTOR
Credential: PH.D.
Phone: 262-347-8848