Provider Demographics
NPI:1639485428
Name:HERPOLSHEIMER, LISA RENAE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:RENAE
Last Name:HERPOLSHEIMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:RENAE
Other - Last Name:TRZEBIATOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:W331 N9103 WEST SHORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029
Mailing Address - Country:US
Mailing Address - Phone:262-744-5201
Mailing Address - Fax:
Practice Address - Street 1:W331 N9103 WEST SHORE DRIVE
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029
Practice Address - Country:US
Practice Address - Phone:262-744-5201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-107951041C0700X
WI7682-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical