Provider Demographics
NPI:1215062948
Name:VANCE, LORRAINE BETH (LCSW)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:BETH
Last Name:VANCE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2376 N 59TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-2214
Mailing Address - Country:US
Mailing Address - Phone:414-453-3224
Mailing Address - Fax:
Practice Address - Street 1:1011 N MAYFAIR RD
Practice Address - Street 2:SUITE 304
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3431
Practice Address - Country:US
Practice Address - Phone:414-453-8380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2575-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical