Provider Demographics
NPI:1295788115
Name:MORESCO-GONIU, CAROL LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:LYNN
Last Name:MORESCO-GONIU
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:N33W23374 GREENBRIAR CT
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-5721
Mailing Address - Country:US
Mailing Address - Phone:627-819-8972
Mailing Address - Fax:
Practice Address - Street 1:7733 W BURLEIGH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-5003
Practice Address - Country:US
Practice Address - Phone:262-347-8848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1151-057103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI06146328001OtherBLUE CROSS BLUE SHIELD
WI39106900Medicaid
WI06146328001OtherBLUE CROSS BLUE SHIELD
WIR97948Medicare UPIN