MEDICARE: KANO PSYCHOTHERAPY LIMITED

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	684-123	WI

General Provider Information

NPI Number	:	1972775773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KANO PSYCHOTHERAPY LIMITED

Provider Business Mailing Address
First Line	:	1301 N ASTOR ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-2887
Country	:	US
Telephone Number	:	414-291-9184
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 N ASTOR ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-2887
Country	:	US
Telephone Number	:	414-291-9184
Fax Number	:

Authorized Official
Title or Position	:	VICE-PRESIDENT
Name	:	MR. RANDALL ALLAN NEFF
Credential	:	LCSW
Telephone Number	:	414-291-9184

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

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