Provider Demographics
NPI:1760921142
Name:LORENZO, JASMIN JENIL (PSYD)
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:JENIL
Last Name:LORENZO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JASMIN
Other - Middle Name:JENIL
Other - Last Name:LORENZO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:HC 60 BOX 12503
Mailing Address - Street 2:BARRIO JAGUEY CHIQUITO, CARR. 411, KM 5.7
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9257
Mailing Address - Country:US
Mailing Address - Phone:787-685-4018
Mailing Address - Fax:787-685-4018
Practice Address - Street 1:HC 60 BOX 12503
Practice Address - Street 2:BARRIO JAGUEY CHIQUITO, CARRETERA 411, KM 5.7
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-9257
Practice Address - Country:US
Practice Address - Phone:787-685-4018
Practice Address - Fax:787-685-4018
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2999103TB0200X, 103TC0700X, 103TC1900X, 103TC2200X, 103TF0000X, 103TH0100X, 103TM1800X, 103TP0016X, 103TP2701X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation