Doctor Name: | IRENE CORZO |
NPI Number: | 1023316809 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | 180007190 |
Business Practice Address: | 772 Main St Suite 203 Lake Geneva, WI - 53147 |
Business Phone Number: | 8478901369 |
Business Fax Number: | |
Mailing Address: | 772 Main St, Suite 203 LAKE GENEVA |
State: | WI |
Postal Code: | 53147 |
Phone Number: | 8478901369 |
Fax Number: | |
NPI Enumeration Date: | 03/03/2011 |
NPI Last Update Date: | 10/15/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 180007190 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |