Provider Demographics
NPI:1407627490
Name:LOURENCO-AMERSON, NATALIA
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:LOURENCO-AMERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6140 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-4630
Mailing Address - Country:US
Mailing Address - Phone:727-243-0337
Mailing Address - Fax:
Practice Address - Street 1:14497 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2047
Practice Address - Country:US
Practice Address - Phone:727-470-6689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL652625046010103K00000X
FLL65262504601103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst