Provider Demographics
NPI:1982634895
Name:LORENTZEN, GLORIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:
Last Name:LORENTZEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:ELDRED
Mailing Address - State:NY
Mailing Address - Zip Code:12732-0265
Mailing Address - Country:US
Mailing Address - Phone:845-699-8036
Mailing Address - Fax:
Practice Address - Street 1:585 STATE ROUTE 55
Practice Address - Street 2:
Practice Address - City:ELDRED
Practice Address - State:NY
Practice Address - Zip Code:12732-5036
Practice Address - Country:US
Practice Address - Phone:845-699-8036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP0615191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN3W841OtherMEDICARE GROUP PIN
NYN3W841OtherMEDICARE GROUP PIN