MEDICARE: WHOLE PATH PSYCHOTHERAPY 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1356061485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLE PATH PSYCHOTHERAPY LLC

Provider Business Mailing Address
First Line	:	3758 S IOWA AVE
Second Line	:
City	:	ST FRANCIS
State	:	WI
Zip	:	53235-4163
Country	:	US
Telephone Number	:	414-501-3161
Fax Number	:	414-246-4238

Provider Business Practice Location Address
First Line	:	234 W FLORIDA ST STE 207
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-1659
Country	:	US
Telephone Number	:	414-501-3161
Fax Number	:	414-246-4238

Authorized Official
Title or Position	:	OWNER & CLINICAL SOCIAL WORKER
Name	:	MEREDITH GOLDBERG
Credential	:	LCSW
Telephone Number	:	414-501-3161

Provider Enumeration Date	:	08/30/2022
Last Update Date	:	01/15/2026

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