Provider Demographics
NPI:1376908988
Name:MAHALLA V. LENZI, PSY. D.
Entity Type:Organization
Organization Name:MAHALLA V. LENZI, PSY. D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MAHALLA
Authorized Official - Middle Name:V
Authorized Official - Last Name:LENZI
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:772-220-3783
Mailing Address - Street 1:211 COLORADO AVE
Mailing Address - Street 2:STE. 6
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2131
Mailing Address - Country:US
Mailing Address - Phone:772-220-3783
Mailing Address - Fax:772-220-8211
Practice Address - Street 1:211 COLORADO AVE
Practice Address - Street 2:STE. 6
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2131
Practice Address - Country:US
Practice Address - Phone:772-220-3783
Practice Address - Fax:772-220-8211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-24
Last Update Date:2015-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3921261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1598814816OtherNPI