Provider Demographics
NPI:1497767651
Name:CHERONE, LAURA J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:J
Last Name:CHERONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 W MORELAND BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-2441
Mailing Address - Country:US
Mailing Address - Phone:262-547-5567
Mailing Address - Fax:262-547-1608
Practice Address - Street 1:414 W MORELAND BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-2441
Practice Address - Country:US
Practice Address - Phone:262-547-5567
Practice Address - Fax:262-547-1608
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI301101YA0400X
WI1467-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39290900Medicaid