Provider Demographics
NPI:1265131270
Name:LORENZO, MARIAM
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:
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 1:3800 PALM AVE APT 217
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4458
Mailing Address - Country:US
Mailing Address - Phone:305-799-9654
Mailing Address - Fax:
Practice Address - Street 1:3800 PALM AVE APT 217
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4458
Practice Address - Country:US
Practice Address - Phone:305-799-9654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-257217106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician