Healthcare Provider Details

I. General information

NPI: 1831301464
Provider Name (Legal Business Name): LAKEVIEW PSYCHOLOGICAL ASSOCIATES SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 MARITIME DR
MANITOWOC WI
54220-2922
US

IV. Provider business mailing address

1020 MARITIME DR
MANITOWOC WI
54220-2922
US

V. Phone/Fax

Practice location:
  • Phone: 920-769-0152
  • Fax: 920-769-0153
Mailing address:
  • Phone: 920-769-0152
  • Fax: 920-769-0153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. GERELYN A CARDUCCI
Title or Position: PSYCHIATRIST CO OWNER
Credential: DO
Phone: 920-769-0152