Healthcare Provider Details

I. General information

NPI: 1841674447
Provider Name (Legal Business Name): MERRA ALBOSTA M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 MILL ST
PLAINFIELD WI
54966-8918
US

IV. Provider business mailing address

117 MILL ST
PLAINFIELD WI
54966-8918
US

V. Phone/Fax

Practice location:
  • Phone: 715-513-6484
  • Fax:
Mailing address:
  • Phone: 715-513-6484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: