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General NPI Number Information
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NPI Number | 1306184171
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Entity Type | Individual
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Provider Name | ADAM NELSON MORIWAKI PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 01/29/2013
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 10425 W NORTH AVE STE 239
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City | WAUWATOSA
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State | WI
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Zip | 53226-2416
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Country | US
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Telephone | 414-909-3014
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Fax |
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Provider Business Mailing Address
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Address Line | 2337 S 95TH ST
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City | WEST ALLIS
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State | WI
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Zip | 53227-2335
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Country | US
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Telephone | 414-403-0966
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3546-57
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License Number State | WI
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