Healthcare Provider Details

I. General information

NPI: 1831368869
Provider Name (Legal Business Name): LORI ESKENAZI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2008
Last Update Date: 02/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 W BROWN DEER RD
BROWN DEER WI
53209-1220
US

IV. Provider business mailing address

9496 N BROADMOOR RD
MILWAUKEE WI
53217-1309
US

V. Phone/Fax

Practice location:
  • Phone: 414-540-2170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7381-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: