Provider Demographics
NPI:1356905996
Name:LORENZO, NICCOLE R (LMHC)
Entity type:Individual
Prefix:
First Name:NICCOLE
Middle Name:R
Last Name:LORENZO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6181 THOMPSON RD STE 803
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-1435
Mailing Address - Country:US
Mailing Address - Phone:315-466-9836
Mailing Address - Fax:315-410-5793
Practice Address - Street 1:6181 THOMPSON RD STE 803
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-1435
Practice Address - Country:US
Practice Address - Phone:315-466-9836
Practice Address - Fax:315-410-5793
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010105101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010105OtherLMHC