MEDICARE: THE THERESIAN INSTITUTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	102L00000X	Psychoanalyst	1760	WI

General Provider Information

NPI Number	:	1013110782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE THERESIAN INSTITUTE

Provider Business Mailing Address
First Line	:	1840 N FARWELL AVE
Second Line	:	SUITE 202
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-1792
Country	:	US
Telephone Number	:	414-223-4748
Fax Number	:

Provider Business Practice Location Address
First Line	:	1840 N FARWELL AVE
Second Line	:	SUITE 202
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-1792
Country	:	US
Telephone Number	:	414-223-4748
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MIRELLA ELISA SACILOTTO-SHARKEY
Credential	:	PH.D.
Telephone Number	:	414-223-4748

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	08/22/2020

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Directions to “THE THERESIAN INSTITUTE ” Practice Location

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