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General NPI Number Information
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NPI Number | 1639830151
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Entity Type | Organization
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Legal Business Name | WISCONSIN PSYCHOLOGY ASSOCIATES, LLC
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Dates
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Enumeration Date | 01/06/2022
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Last Update Date | 02/09/2022
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Provider Practice Location Address
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Address Line | 318 MARGARET CT
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City | BURLINGTON
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State | WI
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Zip | 53105-2330
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Country | US
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Telephone | 812-201-3912
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Fax |
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Provider Business Mailing Address
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Address Line | 318 MARGARET CT
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City | BURLINGTON
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State | WI
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Zip | 53105-2330
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | DR. ROSITA FERNANDEZ
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Credential | PSYD
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Telephone | 812-201-3912
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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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 | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number |
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License Number State |
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