MEDICARE: JULIE ANN BEROSIK MFT IT

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	106H00000X	Marriage & Family Therapist	766-228	WI

General Provider Information

NPI Number	:	1205428265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE ANN BEROSIK MFT IT

Provider Business Mailing Address
First Line	:	150 W 1ST ST # ST270
Second Line	:
City	:	NEW RICHMOND
State	:	WI
Zip	:	54017-1742
Country	:	US
Telephone Number	:	715-246-4840
Fax Number	:	715-254-9459

Provider Business Practice Location Address
First Line	:	150 W 1ST ST # ST270
Second Line	:
City	:	NEW RICHMOND
State	:	WI
Zip	:	54017-1742
Country	:	US
Telephone Number	:	715-246-4840
Fax Number	:	715-254-9459

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

Provider Enumeration Date	:	02/10/2021
Last Update Date	:	02/10/2021

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Directions to “ JULIE ANN BEROSIK MFT IT” Practice Location

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