Provider Demographics
NPI:1790818771
Name:LAUSTSEN, MAUREEN (MA LCSW LMFT)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:
Last Name:LAUSTSEN
Suffix:
Gender:F
Credentials:MA LCSW LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W62 N248 WASHINGTON AVENUE
Mailing Address - Street 2:SUITE #207
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012
Mailing Address - Country:US
Mailing Address - Phone:262-375-1116
Mailing Address - Fax:262-375-1071
Practice Address - Street 1:2363 S 102ND STREET
Practice Address - Street 2:#203
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227
Practice Address - Country:US
Practice Address - Phone:414-545-1950
Practice Address - Fax:414-545-4168
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16401231041C0700X
WI513124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39630200Medicaid