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General NPI Number Information
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NPI Number | 1144702499
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Entity Type | Organization
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Legal Business Name | CATHOLIC CHARITIES INC., DIOCESE OF MADISON
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Dates
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Enumeration Date | 09/04/2018
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Last Update Date | 12/06/2018
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Provider Practice Location Address
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Address Line | 615 E WASHINGTON AVE
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City | MADISON
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State | WI
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Zip | 53703-2952
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Country | US
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Telephone | 608-826-8010
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Fax | 608-826-8027
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Provider Business Mailing Address
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Address Line | 702 S HIGH POINT RD STE 105
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City | MADISON
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State | WI
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Zip | 53719-4926
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Country | US
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Telephone | 608-826-8011
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Fax | 608-826-8027
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Authorized Official
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Title or Position | LCSW
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Name | MISS MERCY M GREENWALD
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Credential | LCSW
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Telephone | 608-826-8010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 8665-123
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License Number State | WI
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