Provider Demographics
NPI:1023316809
Name:CORZO, IRENE (LCPC)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:CORZO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:772 MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147
Mailing Address - Country:US
Mailing Address - Phone:847-890-1369
Mailing Address - Fax:
Practice Address - Street 1:772 MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147
Practice Address - Country:US
Practice Address - Phone:847-890-1369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007190101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health