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General NPI Number Information
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NPI Number | 1487830790
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE CLINICAL AND CONSULTING SERVICES, INC
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Dates
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Enumeration Date | 01/16/2008
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Last Update Date | 01/16/2008
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Provider Practice Location Address
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Address Line | 7161 N PORT WASHINGTON RD SUITE 102
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City | MILWAUKEE
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State | WI
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Zip | 53217-3877
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Country | US
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Telephone | 414-352-7682
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Fax | 414-352-7625
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Provider Business Mailing Address
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Address Line | 7161 N PORT WASHINGTON RD SUITE 102
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City | MILWAUKEE
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State | WI
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Zip | 53217-3877
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Country | US
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Telephone | 414-352-7682
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Fax | 414-352-7625
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. ITZHAK MATUSIAK
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Credential | PHD
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Telephone | 414-352-7682
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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 | 1233
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License Number State | WI
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