Provider Demographics
NPI:1003279753
Name:VERCIMAK, MARIA GLORIA (LPC)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:GLORIA
Last Name:VERCIMAK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:GLORIA
Other - Last Name:SPIEGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:444 N WESTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-5715
Mailing Address - Country:US
Mailing Address - Phone:920-735-7480
Mailing Address - Fax:920-364-2415
Practice Address - Street 1:444 N WESTHILL BLVD
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-5715
Practice Address - Country:US
Practice Address - Phone:920-750-7000
Practice Address - Fax:920-364-2451
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5997-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional