Provider Demographics
NPI:1750876074
Name:MENGAR, LAURA MARIE (LCSW, CAPSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:MENGAR
Suffix:
Gender:F
Credentials:LCSW, CAPSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:WOICEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, CSAC
Mailing Address - Street 1:5363 BALLYDUFF ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-7679
Mailing Address - Country:US
Mailing Address - Phone:920-960-9352
Mailing Address - Fax:
Practice Address - Street 1:5363 BALLYDUFF ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-7679
Practice Address - Country:US
Practice Address - Phone:920-960-9352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
16154132101Y00000X
WI131368104100000X
WI9902-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker