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General NPI Number Information
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NPI Number | 1093124083
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Entity Type | Organization
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Legal Business Name | CHILD AND ADULT PSYCHOTHERAPY CLINIC, LLC
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Dates
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Enumeration Date | 08/04/2014
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Last Update Date | 08/04/2014
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Provider Practice Location Address
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Address Line | 230 W WELLS ST
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City | MILWAUKEE
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State | WI
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Zip | 53203-1866
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Country | US
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Telephone | 414-380-3327
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Fax | 414-276-6819
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Provider Business Mailing Address
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Address Line | 230 W WELLS ST
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City | MILWAUKEE
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State | WI
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Zip | 53203-1866
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Country | US
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Telephone | 414-380-3327
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Fax | 414-276-6819
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | MS. JANICE E. LIEBER
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Credential | M.A.
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Telephone | 414-380-3327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 3394123
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License Number State | WI
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