Provider Demographics
NPI:1922595602
Name:LORENTE, OMAR BRUCE (LMFT)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:BRUCE
Last Name:LORENTE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 AMBER LN
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-1902
Mailing Address - Country:US
Mailing Address - Phone:818-266-2074
Mailing Address - Fax:
Practice Address - Street 1:1201 S VICTORY BLVD STE 206
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2793
Practice Address - Country:US
Practice Address - Phone:626-662-0451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138931106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist