MEDICARE: BENJAMIN M RADER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YP2500X	Professional Counselor
3	106H00000X	Marriage & Family Therapist
4	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1114162187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN M RADER

Provider Business Mailing Address
First Line	:	933 N MAYFAIR RD STE 101
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-3432
Country	:	US
Telephone Number	:	773-398-4648
Fax Number	:	414-249-5443

Provider Business Practice Location Address
First Line	:	933 N MAYFAIR RD STE 101
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-3432
Country	:	US
Telephone Number	:	773-398-4648
Fax Number	:	414-249-5443

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2008
Last Update Date	:	01/12/2019

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Directions to “ BENJAMIN M RADER ” Practice Location

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