Provider Demographics
NPI:1710753702
Name:LORENZO CHAVEZ, YAIMA
Entity Type:Individual
Prefix:
First Name:YAIMA
Middle Name:
Last Name:LORENZO CHAVEZ
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 1:1490 S MILITARY TRL STE 7
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-9141
Mailing Address - Country:US
Mailing Address - Phone:561-323-2552
Mailing Address - Fax:
Practice Address - Street 1:1490 S MILITARY TRL STE 7
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-9141
Practice Address - Country:US
Practice Address - Phone:561-323-2552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-303189106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty