SEBASTIAN FAMILY PSYCHOLOGY PRACTICE LLC NPI 1619011046

NPI Information

NPI: 1619011046
Provider Name: SEBASTIAN FAMILY PSYCHOLOGY PRACTICE, LLC
Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
6025 N GREEN BAY AVE
GLENDALE, WI
ZIP 53209
Phone: (414) 247-0801
Get Directions

SEBASTIAN FAMILY PSYCHOLOGY PRACTICE, LLC is a mental health (including community mental health center) clinic center in Glendale, WI. SEBASTIAN FAMILY PSYCHOLOGY PRACTICE, LLC NPI is 1619011046. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

6025 N GREEN BAY AVE
GLENDALE, WI
ZIP 53209-811
Phone: (414) 247-0801
Fax: (414) 247-0816

The provider's authorized official is Sebastian L Ssempijja .
The authorized official title is Clinic Director and has the following contact phone number (414) 915-2967.

The enumeration date for this NPI number is 2/18/2007 and was last updated on 7/20/2023.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	103TB0200X	Psychologist	Cognitive & Behavioral	1784-057	WISCONSIN	No
2	103TC0700X	Psychologist	Clinical	1784-057	WISCONSIN	No
3	103TC2200X	Psychologist	Clinical Child & Adolescent	1784-057	WISCONSIN	No
4	104100000X	Social Worker		126576-121	WISCONSIN	No
5	104100000X	Social Worker		3079-123	WISCONSIN	No
6	104100000X	Social Worker		302-123	WISCONSIN	No
7	104100000X	Social Worker		160-123	WISCONSIN	No
8	171R00000X	Interpreter				No
9	103T00000X	Psychologist		1784-057	WISCONSIN	No
10	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)			Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	42236700	MEDICAID	WISCONSIN

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: 4/28/2024

NPI Synchronization or Removal

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