Provider Demographics
NPI:1568480937
Name:LORENZO, SANDRA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:LORENZO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113-14 72ND ROAD
Mailing Address - Street 2:APARTMENT 5A
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4613
Mailing Address - Country:US
Mailing Address - Phone:718-268-7960
Mailing Address - Fax:
Practice Address - Street 1:18730 GRAND CENTRAL PKWY
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5819
Practice Address - Country:US
Practice Address - Phone:718-264-2931
Practice Address - Fax:718-264-3030
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071143-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244624Medicaid