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NPI Code Detail

MEDICARE: LISA RIOS-OLIVARES MSW

MEDICARE:   LISA  RIOS-OLIVARES  MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor3672-125WI

General Provider Information

NPI Number : 1598796492
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA RIOS-OLIVARES MSW
Provider Business Mailing Address
First Line : 4109 67TH ST
Second Line :
City : KENOSHA
State : WI
Zip : 53142-3836
Country : US
Telephone Number : 262-652-9830
Fax Number : 262-652-2931
Provider Business Practice Location Address
First Line : 4109 67TH ST
Second Line :
City : KENOSHA
State : WI
Zip : 53142-3836
Country : US
Telephone Number : 262-652-9830
Fax Number : 262-652-2931
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2006
Last Update Date : 07/08/2007

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Directions to “ LISA RIOS-OLIVARES MSW” Practice Location

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