Organization
WISCONSIN PSYCHOLOGY ASSOCIATES, LLC
Active
Organization
WISCONSIN PSYCHOLOGY ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROSITA FERNANDEZ PSYD (OWNER/PSYCHOLOGIST)
(812) 201-3912
Entity
Organization
Contact information
Practice address
318 MARGARET CT, BURLINGTON, WI 53105-2330
(812) 201-3912
Mailing address
318 MARGARET CT, BURLINGTON, WI 53105-2330
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
103TH0100X
Health Service Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376062851
—
WI
05
—
300007198IN
—
IN
Enumeration date
01/06/2022
Last updated
02/09/2022
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