Provider Demographics
NPI:1912952623
Name:LORENZ, AMANDA R (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:R
Last Name:LORENZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9216 KEYSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1737
Mailing Address - Country:US
Mailing Address - Phone:630-344-9880
Mailing Address - Fax:
Practice Address - Street 1:9216 KEYSTONE AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1737
Practice Address - Country:US
Practice Address - Phone:630-344-9880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002854103TC0700X
IL071-008155103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA164273688AMedicaid
Q41015Medicare UPIN
GA68BBGMVMedicare ID - Type Unspecified