Organization
WI CBT CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWIN BACALSO LCSW (THERAPIST)
(414) 367-4447
Entity
Organization
Contact information
Practice address
5215 N IRONWOOD RD, SUITE 202 PMB 1013, GLENDALE, WI 53217
(414) 367-4447
Mailing address
5215 N IRONWOOD RD, SUITE 202 PMB 1013, GLENDALE, WI 53217
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
04/10/2024
Last updated
05/07/2024
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