Provider Demographics
NPI:1083121073
Name:LUSKI, LORENA (ITDS)
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:LUSKI
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 W 84TH ST STE 58
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-3379
Mailing Address - Country:US
Mailing Address - Phone:305-985-6122
Mailing Address - Fax:
Practice Address - Street 1:1550 W 84TH ST STE 58
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-3379
Practice Address - Country:US
Practice Address - Phone:305-985-6122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist