Provider Demographics
NPI:1952139156
Name:MORENO LORENZO, MARY KARLA
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KARLA
Last Name:MORENO 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 1:1205 NW 26TH PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-4704
Mailing Address - Country:US
Mailing Address - Phone:702-470-3279
Mailing Address - Fax:
Practice Address - Street 1:1205 NW 26TH PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33993-4704
Practice Address - Country:US
Practice Address - Phone:702-470-3279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician