Provider Demographics
NPI:1043450174
Name:VINCENT, VERONICA MARIE (LCSW, CEAP)
Entity Type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:MARIE
Last Name:VINCENT
Suffix:
Gender:F
Credentials:LCSW, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12627 N MAPLE CREST LN
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-2517
Mailing Address - Country:US
Mailing Address - Phone:262-243-5666
Mailing Address - Fax:262-243-5665
Practice Address - Street 1:10201 W LINCOLN AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2136
Practice Address - Country:US
Practice Address - Phone:262-243-5666
Practice Address - Fax:262-243-5665
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2691-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11833611OtherCAQH