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PEDIATRIC PSYCHOLOGY ASSOCIATES LLC NPI 1124193065


NPI Information

NPI: 1124193065
Provider Name: PEDIATRIC PSYCHOLOGY ASSOCIATES LLC

Doing Business As: AUTISM BEHAVIORAL NETWORK

Classification: Psychologist - 103TC0700X
Entity Type: Organization

Specialization: Clinical

Address:
3636 N 124TH ST
3RD FLOOR
WAUWATOSA, WI
ZIP 53222
Phone: (414) 476-9755
Get Directions

PEDIATRIC PSYCHOLOGY ASSOCIATES LLC is a clinical psychologist in Wauwatosa, WI. The provider is a psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems. PEDIATRIC PSYCHOLOGY ASSOCIATES LLC NPI is 1124193065. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Autism Behavioral Network.

The provider's business location address is:

3636 N 124TH ST
3RD FLOOR
WAUWATOSA, WI
ZIP 53222-125
Phone: (414) 476-9755
Fax: (414) 476-3413

The provider's authorized official is Tracy R Pritzl .
The authorized official title is Director Owner and has the following contact phone number (414) 476-9755.

The enumeration date for this NPI number is 11/22/2006 and was last updated on 9/27/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1103TC0700XPsychologistClinical613 057WISCONSINYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
142212500MEDICAIDWISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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