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NPI Code Detail

MEDICARE: MS. RAINBOW ANDREA MARIFROG LMFT

MEDICARE: MS. RAINBOW ANDREA MARIFROG LMFT
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
1106H00000XMarriage & Family Therapist124-919WI

General Provider Information

NPI Number : 1407918329
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. RAINBOW ANDREA MARIFROG LMFT
Provider Business Mailing Address
First Line : 2917 INTERNATIONAL LN STE 202
Second Line :
City : MADISON
State : WI
Zip : 53704-3135
Country : US
Telephone Number : 608-520-6207
Fax Number : 608-646-7531
Provider Business Practice Location Address
First Line : 2917 INTERNATIONAL LN STE 202
Second Line :
City : MADISON
State : WI
Zip : 53704-3135
Country : US
Telephone Number : 608-520-6207
Fax Number : 608-646-7531
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2006
Last Update Date : 04/02/2024

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