LIFESOURCE OF NORTH CAROLINA (NPI# 1871135723) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1871135723 |
Entity Type | Organization |
Organization Name | LIFESOURCE OF NORTH CAROLINA |
Practice Address |
3540 S 43rd St Milwaukee WI 53220-1502 |
Mailing Address |
Po Box 538622 Atlanta GA 30353-8622 |
Practice Telephone | 9107429243 |
Practice Fax Number | 8887461787 |
Mailing Telephone | 9107429243 |
Mailing Fax Number | 8887461787 |
Enumeration Date | 2019-10-11 |
Last Update Date | 2019-10-14 |
Authorized Official Name | PEGGY BADDOUR (PRESIDENT/OWNER) |
Authorized Official Telephone | 9105351211 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 103TC0700X |
Psychologist Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians | ||
N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
Y | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1497378848 | Lifesource of North Carolina | Psychologist | 8315 Zimpel St, New Orleans, LA 70118-1169 | 2020-05-20 |
1649877762 | Lifesource of North Carolina | Psychologist | 501 2nd St, Menominee, MI 49858-3203 | 2020-10-01 |
1972131308 | Lifesource of North Carolina | Psychologist | 140 Park Ave, Bloomfield, CT 06002-3207 | 2020-03-31 |
1619515277 | Lifesource of North Carolina | Psychologist | 204 W Main St, New London, OH 44851-1070 | 2019-12-13 |
1801431127 | Lifesource of North Carolina | Psychologist | 725 2nd Ave S, Hopkins, MN 55343-7782 | 2019-11-11 |
1174168496 | Lifesource of North Carolina | Psychologist | 600 Main St S, Minot, ND 58701-4499 | 2019-11-11 |
1801431440 | Lifesource of North Carolina | Psychologist | 1728 W 8th St, Cedar Falls, IA 50613-2002 | 2019-11-07 |
1093350647 | Lifesource of North Carolina | Psychologist | 2900 W E St, North Platte, NE 69101-1803 | 2019-11-07 |
1538728183 | Lifesource of North Carolina | Psychologist | 200 Nursing Home Ln, Pikeville, KY 41501-6896 | 2019-06-07 |
1730648288 | Lifesource of North Carolina | Social Worker | 5530 Northrop Rd, Milton, FL 32570-8701 | 2019-03-14 |
Entity Type | Entity Name | Entity Address |
---|---|---|
Virginia Business Entities | LifeSource of North Carolina Inc. | 5617 Maxwell Place, Wilmington, North Carolina 28408 |
Alabama Business Registrations | LifeSource of North Carolina, Inc. | 5617 Maxwell Place, Wilmington, NC 28409 |
Street Address |
3540 S 43RD ST |
City | MILWAUKEE |
State | WI |
Zip Code | 53220-1502 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1649312000 | Rachel Ruthann Burton | Occupational Therapist | 3540 S 43rd St, Milwaukee, WI 53220-1502 | 2007-02-13 |
1205487444 | Shane David Frasher | Occupational Therapy Assistant | 3540 S 43rd St, Milwaukee, WI 53220-1502 | 2019-09-27 |
1710538640 | Kathleen Ann Shields | Physical Therapist | 3540 S 43rd St, Milwaukee, WI 53220-1502 | 2019-09-23 |
1487172276 | Nsh Sunrise LLC | Skilled Nursing Facility | 3540 S 43rd St, Milwaukee, WI 53220-1502 | 2017-09-01 |
1205202959 | Jordan Marsh | Occupational Therapy Assistant | 3540 S 43rd St, Milwaukee, WI 53220-1502 | 2015-08-18 |
1346639143 | Fmg South 43rd Street Wisconsin LLC | Skilled Nursing Facility | 3540 S 43rd St, Milwaukee, WI 53220-1502 | 2015-01-16 |
1518201573 | Jamie Nicole Scott | Physical Therapy Assistant | 3540 S 43rd St, Milwaukee, WI 53220-1502 | 2012-11-15 |
1841554318 | Emily Igl | Speech-Language Pathologist | 3540 S 43rd St, Milwaukee, WI 53220-1502 | 2012-06-29 |
1093078859 | Tammy Peterson | Physical Therapy Assistant | 3540 S 43rd St, Milwaukee, WI 53220-1502 | 2012-06-18 |
1659669349 | Jenna N Maliszewski | Skilled Nursing Facility | 3540 S 43rd St, Milwaukee, WI 53220-1502 | 2011-07-14 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1871061069 | Kathleen Elizabeth White | Orthotist | 6790 W. Layton Ave, Greenfield, WI 53220 | 2018-11-06 |
1992284087 | Froedtert & The Medical College of Wisconsin Community Physicians | Non-Pharmacy Dispensing Site | 4859 South 60th Street, Greenfield, WI 53220 | 2018-08-09 |
1609394220 | Aaron Park | Speech-Language Pathologist | 3540 S. 43rd St., Milwaukee, WI 53220 | 2017-09-04 |
1730601675 | Rosaana Avila | Physical Therapist | 3944 S. 60th St., Milwaukee, WI 53220 | 2017-07-12 |
1285002667 | Casey E Reis | Nurse Practitioner | 4848 S. 76th Street, Greenfield, WI 53220 | 2015-09-02 |
1437539798 | Luke Robert Garceau | Physical Therapist | 6520 W. Layton Ave #101, Greenfield, WI 53220 | 2015-06-02 |
1295139012 | Tammy Giannopoulos, LLC | Clinic/Center | 4402 S 68th St Suite 100, Greenfield, WI 53220 | 2014-10-22 |
1861754244 | Lakeshore Medical Clinic | Occupational Therapist | 4444 West Loomis Road, 200, Greenfield, WI 53220 | 2012-06-12 |
1598083115 | Rebecca Anne Kappes | Licensed Practical Nurse | 8208 W Tripoli, Milwaukee, WI 53220 | 2010-05-06 |
1699941005 | Susan Marie Delaet | Physical Therapy Assistant | 5700 West Layton Ave, Greenfield, WI 53220 | 2008-05-06 |
Find all providers in zip 53220 |
Taxonomy Code | 1041C0700X |
Grouping | Behavioral Health & Social Service Providers |
Classification | Social Worker |
Specialization | Clinical |
A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1912506908 | Compassionate Clinical Services, LLC | Social Worker | 1314 S 1st St # 210, Milwaukee, WI 53204-2405 | 2020-10-20 |
1659986560 | Association of Community Empowerment, LLC | Social Worker | 3500 N Sherman Blvd Ste 303, Milwaukee, WI 53216-3463 | 2020-09-09 |
1316550205 | Ellice Plant | Social Worker | 2643 N Newhall St, Milwaukee, WI 53211-3517 | 2020-08-28 |
1801407895 | Maxine Fran Rabinowe | Social Worker | 1943 N Summit Ave Apt 14, Milwaukee, WI 53202-1386 | 2020-08-12 |
1255953527 | Susan C. Donnelly | Social Worker | 191 N Broadway Unit 205, Milwaukee, WI 53202-6031 | 2020-05-10 |
1013556885 | Shalonda Renee Leflore | Social Worker | 3244 N 48th St, Milwaukee, WI 53216-3344 | 2019-12-27 |
1003458068 | Anaddia S Clark | Social Worker | 4929 W Fond Du Lac Aveune, Milwaukee, WI 53216-2324 | 2019-10-11 |
1639727258 | Lauren Marie Kubik | Social Worker | 2375 N 67th St, Milwaukee, WI 53213-1438 | 2019-08-27 |
1164077319 | Casey Mccarragher | Social Worker | 3330 W Wells St, Milwaukee, WI 53208-3333 | 2019-08-05 |
1023661659 | Edwin Bacalso | Social Worker | 2524 E Webster Pl Ste 203, Milwaukee, WI 53211-4257 | 2019-07-23 |
Find all providers in MILWAUKEE |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.