Provider Demographics
NPI:1962913012
Name:GOLEMI, NINA SERENE (MA, LPC)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:SERENE
Last Name:GOLEMI
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 WEST STREET
Mailing Address - Street 2:SUITE 814
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094-3608
Mailing Address - Country:US
Mailing Address - Phone:920-248-0578
Mailing Address - Fax:
Practice Address - Street 1:300 N 3RD ST STE 112
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-3723
Practice Address - Country:US
Practice Address - Phone:920-545-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7351-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health