Provider Demographics
NPI:1134718109
Name:LORENZO, ALICIA SILVIA
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:SILVIA
Last Name:LORENZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 E 9TH ST APT 9
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4235
Mailing Address - Country:US
Mailing Address - Phone:786-484-3254
Mailing Address - Fax:
Practice Address - Street 1:165 E 9TH ST APT 9
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4235
Practice Address - Country:US
Practice Address - Phone:786-484-3254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108474000Medicaid