Provider Demographics
NPI:1639683881
Name:HIDALGO, LORENS
Entity Type:Individual
Prefix:
First Name:LORENS
Middle Name:
Last Name:HIDALGO
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 1:2 PARK AVENUE TER APT 4
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-1500
Mailing Address - Country:US
Mailing Address - Phone:914-964-7324
Mailing Address - Fax:914-964-7321
Practice Address - Street 1:2 PARK AVENUE TER APT 4
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-1500
Practice Address - Country:US
Practice Address - Phone:914-964-7324
Practice Address - Fax:914-964-7321
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102300-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker