Healthcare Provider Details

I. General information

NPI: 1407969413
Provider Name (Legal Business Name): LORENE MENCHACA LCSW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E PIER ST
PORT WASHINGTON WI
53074-1939
US

IV. Provider business mailing address

285 N JANACEK RD
BROOKFIELD WI
53045-6102
US

V. Phone/Fax

Practice location:
  • Phone: 262-284-3117
  • Fax: 262-284-3087
Mailing address:
  • Phone: 262-641-9050
  • Fax: 262-641-9126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2540-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: