Provider Demographics
NPI:1235647504
Name:ADAM N. MORIWAKI, PSY.D., LLC
Entity type:Organization
Organization Name:ADAM N. MORIWAKI, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:MORIWAKI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:414-403-0966
Mailing Address - Street 1:2337 S 95TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2335
Mailing Address - Country:US
Mailing Address - Phone:414-403-0966
Mailing Address - Fax:
Practice Address - Street 1:10425 W NORTH AVE STE 239
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2416
Practice Address - Country:US
Practice Address - Phone:414-909-3014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3546-57261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health