MEDICARE: VIBRANT CHILD PSYCHOLOGY SERVICES LLC

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1104648369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIBRANT CHILD PSYCHOLOGY SERVICES LLC

Provider Business Mailing Address
First Line	:	2945 N 84TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-4705
Country	:	US
Telephone Number	:	414-687-1285
Fax Number	:	414-310-0560

Provider Business Practice Location Address
First Line	:	10150 W NATIONAL AVE STE 315
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53227-2153
Country	:	US
Telephone Number	:	262-668-8870
Fax Number	:	414-310-0560

Authorized Official
Title or Position	:	OWNER
Name	:	JILL DELIE
Credential	:	PSYD
Telephone Number	:	414-687-1285

Provider Enumeration Date	:	10/29/2024
Last Update Date	:	10/29/2024

Similar Medicare Providers

1497832083 — DR. LYSA CHARLES MD
Practice Location Address:

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308

1699383703 — WEST ALLIS SURGERY CENTER LLC
Practice Location Address:

10150 W NATIONAL AVE STE 350
WEST ALLIS, WI
53227-2153

Practice Phone: 414-296-0039
Practice Fax:

1043482417 — AMBULATORY SURGERY, INC
Practice Location Address:

10150 W NATIONAL AVE STE 350
MILWAUKEE, WI
53227-2153

Practice Phone: 414-257-3322
Practice Fax: 414-257-3364

1114299104 — GARY R. HUSTON D.O., INC
Practice Location Address:

177 WEST ST
CONNEAUT, OH
44030-2153

Practice Phone: 440-593-6551
Practice Fax: 440-593-6522

1063827491 — CONNEAUT PSYCHIATRIC SERVICES, LLC
Practice Location Address:

177 WEST ST
CONNEAUT, OH
44030-2153

Practice Phone: 440-228-0506
Practice Fax: 440-593-5799

1861170805 — RENE FERNANDO DOMINGUEZ RODRIGUEZ
Practice Location Address:

2153 PEPPER RD
WEST PALM BEACH, FL
33415-7005

Practice Phone: 561-698-2785
Practice Fax:

Directions to “VIBRANT CHILD PSYCHOLOGY SERVICES LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.