Organization
FAMILY THERAPY CENTER OF MADISON, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL FAYNIK (PRESIDENT/TREASURER)
(608) 276-9191
Entity
Organization
Contact information
Practice address
700 RAY O VAC DR, SUITE 220, MADISON, WI 53711-2479
(608) 276-9191
(608) 276-9144
Mailing address
700 RAY O VAC DR, SUITE 220, MADISON, WI 53711-2479
(608) 276-9191
(608) 276-9144
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42111900
—
WI
Enumeration date
12/27/2006
Last updated
10/25/2013
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