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Individual
MR. LAWRENCE MICHAEL WIECZOREK
Active
Individual
MR. LAWRENCE MICHAEL WIECZOREK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02273040
BLUE CROSS BLUE SHIELD
IL
01
—
04971454
BLUE CROSS BLUE SHIELD
IL
Enumeration date
09/21/2006
Last updated
07/08/2007
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