Provider Demographics
NPI:1811399975
Name:LORENZO, LISA (MT-BC, NICU MT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:LORENZO
Suffix:
Gender:F
Credentials:MT-BC, NICU MT
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:RHOADS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT-BC, NICU MT
Mailing Address - Street 1:PO BOX 11253
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32302-3253
Mailing Address - Country:US
Mailing Address - Phone:352-361-7771
Mailing Address - Fax:
Practice Address - Street 1:322 BEARD ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-6228
Practice Address - Country:US
Practice Address - Phone:850-778-2132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-19
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10178225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist