Provider Demographics
NPI:1508833435
Name:LECAIRE, BARBARA K
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:K
Last Name:LECAIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:K
Other - Last Name:DELFORGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:529 S JEFFERSON ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-4125
Mailing Address - Country:US
Mailing Address - Phone:920-884-6700
Mailing Address - Fax:920-227-2273
Practice Address - Street 1:529 S JEFFERSON ST
Practice Address - Street 2:SUITE 105
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-4125
Practice Address - Country:US
Practice Address - Phone:920-884-6700
Practice Address - Fax:920-227-2273
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3124-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39607100Medicaid
WI39607100Medicaid