Provider Demographics
NPI:1396523882
Name:HOLD SPACE THERAPY LCSW, PLLC
Entity type:Organization
Organization Name:HOLD SPACE THERAPY LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LORENZO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:518-350-4903
Mailing Address - Street 1:364 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2807
Mailing Address - Country:US
Mailing Address - Phone:518-350-4903
Mailing Address - Fax:
Practice Address - Street 1:364 5TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-2807
Practice Address - Country:US
Practice Address - Phone:518-350-4903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty