Provider Demographics
NPI:1063629715
Name:LORENZO, SAMANTHA (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:LORENZO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17020 NW 78TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3802
Mailing Address - Country:US
Mailing Address - Phone:786-234-1181
Mailing Address - Fax:
Practice Address - Street 1:2810 NW SOUTH RIVER DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1120
Practice Address - Country:US
Practice Address - Phone:305-636-3538
Practice Address - Fax:305-636-3539
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8084101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003027300Medicaid