Provider Demographics
NPI:1679547632
Name:WISNIEWSKI, LUCENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LUCENE
Middle Name:
Last Name:WISNIEWSKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35900 EUCLID AVE
Mailing Address - Street 2:LAURELWOOD HOSPITAL
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094
Mailing Address - Country:US
Mailing Address - Phone:440-954-3419
Mailing Address - Fax:440-953-3331
Practice Address - Street 1:35900 EUCLID AVE
Practice Address - Street 2:LAURELWOOD HOSPITAL
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094
Practice Address - Country:US
Practice Address - Phone:440-954-3419
Practice Address - Fax:440-953-3331
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5717103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist