Provider Demographics
NPI:1457714735
Name:IRENE CORZO AND ASSOCIATES, LLC
Entity Type:Organization
Organization Name:IRENE CORZO AND ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORZO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:262-374-4970
Mailing Address - Street 1:772 W MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-1835
Mailing Address - Country:US
Mailing Address - Phone:262-374-4970
Mailing Address - Fax:
Practice Address - Street 1:772 W MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-1835
Practice Address - Country:US
Practice Address - Phone:262-374-4970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-03
Last Update Date:2016-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty