Provider Demographics
NPI:1720830847
Name:RAINBOW MARIFROG, LLC
Entity type:Organization
Organization Name:RAINBOW MARIFROG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:RAINBOW
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIFROG
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:608-520-6207
Mailing Address - Street 1:2917 INTERNATIONAL LN STE 202
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3135
Mailing Address - Country:US
Mailing Address - Phone:608-520-6207
Mailing Address - Fax:608-646-7531
Practice Address - Street 1:2917 INTERNATIONAL LN STE 202
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3135
Practice Address - Country:US
Practice Address - Phone:608-520-6207
Practice Address - Fax:608-646-7531
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAINBOW MARIFROG, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty