Provider Demographics
NPI:1760720932
Name:CECCATO, LAURA (MS, LPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CECCATO
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:SWAAB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:414-389-2377
Mailing Address - Fax:
Practice Address - Street 1:1220 DEWEY AVE
Practice Address - Street 2:BUILDING #11, DEWEY CENTER
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-2504
Practice Address - Country:US
Practice Address - Phone:414-454-6633
Practice Address - Fax:414-454-6747
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15831-131101YA0400X
WI4906-125101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100028290Medicaid