Healthcare Provider Details

I. General information

NPI: 1699107417
Provider Name (Legal Business Name): BRITTANY MATHEWS PHD, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE CHILD AND ADOLESCENT PSYCHIATRY
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

9000 W WISCONSIN AVE CHILD AND ADOLESCENT PSYCHIATRY
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-2932
  • Fax: 414-266-3735
Mailing address:
  • Phone: 414-266-2932
  • Fax: 414-266-3735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number3392
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3392 - 57
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: