Lakeshore Clinic LTD

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

1497 Issued in WI

Legal business name

LAKESHORE CLINIC LTD

Practice address

3970 N Oakland Ave
Suite 502
Milwaukee, WI 53211

Phone

(414) 962-9909

Fax

(414) 332-8596

NPI assigned

Nov 7, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Patricia K Briceno, MS LCSW

Title

Administrator

Phone

(414) 962-9909

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407925985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3970 N OAKLAND AVE",
            "address_2": "SUITE 502",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53211",
            "telephone_number": "414-962-9909",
            "fax_number": "414-332-8596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3970 N OAKLAND AVE",
            "address_2": "SUITE 502",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53211",
            "telephone_number": "414-962-9909",
            "fax_number": "414-332-8596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE CLINIC LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRICENO",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "414-962-9909",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MS LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "WI",
            "license": "1497",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42106900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anne E B Lakatos, APN-BC, APNP, RN
• Lake Park Dental LLC
• Lake Terrace Nursing and Rehab LLC
• Jacqueline Lake, NP
• Jodi Jay Lake, R.N.
• Lakeshore Medical Clinic
• Lakeshore Medical Clinic, LLC
• Lakeshore Medical Clinic, LTD
• Lakeshore Medical Clinic, LTD
• Lakeside Dental LLC

• Mental Health Clinic/Center (Including Community Mental Health Center) in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.