Provider Demographics
NPI:1255600854
Name:LORENZO, KRISTIN P (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:P
Last Name:LORENZO
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 1:47 FAIRBANKS AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2721
Mailing Address - Country:US
Mailing Address - Phone:718-226-6558
Mailing Address - Fax:718-226-6578
Practice Address - Street 1:450 SEAVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3401
Practice Address - Country:US
Practice Address - Phone:718-226-6558
Practice Address - Fax:718-226-6578
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079150-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical