Organization
LAKESHORE CLINIC LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PATRICIA K BRICENO MS LCSW (ADMINISTRATOR)
(414) 962-9909
Entity
Organization
Contact information
Practice address
3970 N OAKLAND AVE, SUITE 502, MILWAUKEE, WI 53211
(414) 962-9909
(414) 332-8596
Mailing address
3970 N OAKLAND AVE, SUITE 502, MILWAUKEE, WI 53211
(414) 962-9909
(414) 332-8596
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
1497
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42106900
—
WI
Enumeration date
11/07/2006
Last updated
08/22/2020
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