Provider Demographics
NPI:1598814816
Name:LENZI, MAHALLA VERONICA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MAHALLA
Middle Name:VERONICA
Last Name:LENZI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 SE OSCEOLA STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2503
Mailing Address - Country:US
Mailing Address - Phone:772-220-3783
Mailing Address - Fax:
Practice Address - Street 1:401 SE OSCEOLA STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2503
Practice Address - Country:US
Practice Address - Phone:772-220-3783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003921103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046776OtherVALUE OPTIONS
FL73359OtherBLUE CROSS
FL046776OtherVALUE OPTIONS