Provider Demographics
NPI:1235840844
Name:LORENZO, MARK F JR (CPSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:F
Last Name:LORENZO
Suffix:JR
Gender:M
Credentials:CPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:PUEBLO OF ACOMA
Mailing Address - State:NM
Mailing Address - Zip Code:87034-0328
Mailing Address - Country:US
Mailing Address - Phone:505-552-6661
Mailing Address - Fax:
Practice Address - Street 1:45 PINSBAARI DR
Practice Address - Street 2:
Practice Address - City:PUEBLO OF ACOMA
Practice Address - State:NM
Practice Address - Zip Code:87034
Practice Address - Country:US
Practice Address - Phone:505-552-6661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator