Healthcare Provider Details

I. General information

NPI: 1376013516
Provider Name (Legal Business Name): MULTICULTURAL TRAUMA AND ADDICTION TREATMENT CENTER OF WISCONSIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N MAYFAIR RD STE 120
WAUWATOSA WI
53226-2262
US

IV. Provider business mailing address

2222 N MAYFAIR RD STE 120
WAUWATOSA WI
53226-2262
US

V. Phone/Fax

Practice location:
  • Phone: 414-939-9390
  • Fax: 414-939-9383
Mailing address:
  • Phone: 414-939-9390
  • Fax: 414-939-9383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIA AMARANTE
Title or Position: PH.D / OWNER
Credential: LPC
Phone: 973-876-3663