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General NPI Number Information
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NPI Number | 1336563725
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Entity Type | Organization
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Legal Business Name | COMMUNITY SUPPORT NETWORK, INC
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Dates
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Enumeration Date | 02/06/2014
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Last Update Date | 07/22/2014
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Provider Practice Location Address
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Address Line | 1191 N SHERMAN AVE
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City | MADISON
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State | WI
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Zip | 53704-4234
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Country | US
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Telephone | 608-421-3239
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Fax | 608-270-2238
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Provider Business Mailing Address
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Address Line | 1137 N SHERMAN AVE
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City | MADISON
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State | WI
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Zip | 53704-4234
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Country | US
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Telephone | 608-421-3239
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Fax | 608-270-2238
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. DEBORAH KORSOWER RAETTIG
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Credential | MSSW
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Telephone | 608-421-3239
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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