Provider Demographics
NPI:1790958973
Name:LUNOG, KEVIN P (LCSW, CSAC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:P
Last Name:LUNOG
Suffix:
Gender:M
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HICKORY STREET
Mailing Address - Street 2:
Mailing Address - City:MAUSTON
Mailing Address - State:WI
Mailing Address - Zip Code:53948
Mailing Address - Country:US
Mailing Address - Phone:608-847-2400
Mailing Address - Fax:608-847-9599
Practice Address - Street 1:200 HICKORY STREET
Practice Address - Street 2:
Practice Address - City:MAUSTON
Practice Address - State:WI
Practice Address - Zip Code:53948
Practice Address - Country:US
Practice Address - Phone:608-847-2400
Practice Address - Fax:608-847-9599
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1594-132101YA0400X
WI1020101YP2500X
WI1020-125101YP2500X
WI31911041C0700X
WI3191-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39273700Medicaid