Organization
RIVERSIDE PSYCHIATRIC GROUP SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HOWARD W DAVIS MD (PRESIDENT)
(920) 338-2800
Entity
Organization
Contact information
Practice address
1325 ANGELS PATH RD, DE PERE, WI 54115-4050
(920) 338-2855
(920) 338-9270
Mailing address
1325 ANGELS PATH RD, DE PERE, WI 54115-4050
(920) 338-2855
(920) 338-9270
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
WI
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
WI
103T00000X
Psychologist
—
WI
1041C0700X
Clinical Social Worker
—
WI
106H00000X
Marriage & Family Therapist
—
WI
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32884100
—
WI
Enumeration date
07/17/2007
Last updated
01/14/2009
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