Provider Demographics
NPI:1568544310
Name:LAURENT, DANIEL W (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:W
Last Name:LAURENT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W RIVER DRIVE
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53090
Mailing Address - Country:US
Mailing Address - Phone:262-338-2717
Mailing Address - Fax:262-338-9767
Practice Address - Street 1:400 W RIVER DRIVE
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53090
Practice Address - Country:US
Practice Address - Phone:262-338-2717
Practice Address - Fax:262-338-9767
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2004101YA0400X
WI3229-123104100000X
WI11912104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker