Provider Demographics
NPI:1306500699
Name:FLOREZ, MARGO (LCSW, CSAC)
Entity type:Individual
Prefix:
First Name:MARGO
Middle Name:
Last Name:FLOREZ
Suffix:
Gender:F
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3902 MILWAUKEE ST # W519
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53707-5001
Mailing Address - Country:US
Mailing Address - Phone:414-928-1244
Mailing Address - Fax:
Practice Address - Street 1:3902 MILWAUKEE ST # W519
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53707-5001
Practice Address - Country:US
Practice Address - Phone:414-928-1244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-24
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X
WI16521-131101YA0400X
WI128150104100000X
WI98331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker