Healthcare Provider Details

I. General information

NPI: 1427554278
Provider Name (Legal Business Name): LUCINDA R BRIESEMEISTER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3229 S RIVERSIDE DR
BELOIT WI
53511-1530
US

IV. Provider business mailing address

619 RIVER ST
BELLEVILLE WI
53508-9188
US

V. Phone/Fax

Practice location:
  • Phone: 608-856-4296
  • Fax:
Mailing address:
  • Phone: 608-424-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number131139-121
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9429-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: