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General NPI Number Information
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NPI Number | 1720132806
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Entity Type | Organization
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Legal Business Name | HARBOR COMMUNITY PSYCHOLOGICAL ASSOCIATES SC
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 01/29/2014
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Provider Practice Location Address
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Address Line | 2701 LARSEN RD
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City | GREEN BAY
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State | WI
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Zip | 54303-4863
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Country | US
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Telephone | 920-606-8734
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Fax | 866-201-3050
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Provider Business Mailing Address
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Address Line | PO BOX 5714
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City | DE PERE
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State | WI
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Zip | 54115-5714
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Country | US
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Telephone | 920-606-8734
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Fax | 866-201-3050
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | BARBARA ANN ROOS
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Credential | CPC
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Telephone | 630-541-5040
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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 | 1598-057
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License Number State | WI
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