Provider Demographics
NPI:1790853166
Name:LORENZO, OMAR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:LORENZO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 NW 151ST ST STE 202
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2437
Mailing Address - Country:US
Mailing Address - Phone:305-557-6755
Mailing Address - Fax:305-557-1636
Practice Address - Street 1:5801 NW 151ST ST STE 202
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2437
Practice Address - Country:US
Practice Address - Phone:305-557-6755
Practice Address - Fax:305-557-1636
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7210103G00000X, 103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75335OtherBLUE CROSS BLUE SHIELD
FL11606395OtherCAQH PROVIDER ID
FLU6469AMedicare NSC