Provider Demographics
NPI:1285839373
Name:DEHERRERA, LORENZO J (EDD)
Entity Type:Individual
Prefix:DR
First Name:LORENZO
Middle Name:J
Last Name:DEHERRERA
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:DR
Other - First Name:LARRY
Other - Middle Name:J
Other - Last Name:DEHERRERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD
Mailing Address - Street 1:2534 125TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1534
Mailing Address - Country:US
Mailing Address - Phone:425-869-2795
Mailing Address - Fax:425-883-7964
Practice Address - Street 1:2534 125TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1534
Practice Address - Country:US
Practice Address - Phone:425-869-2795
Practice Address - Fax:425-883-7964
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005591101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAD 6220OtherREGENCE BLUESHIELD