Provider Demographics
NPI:1952725160
Name:LORENZO, JOHANNA (MS)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:LORENZO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 10991
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-9789
Mailing Address - Country:US
Mailing Address - Phone:787-226-3599
Mailing Address - Fax:
Practice Address - Street 1:CALLE VENTURA GANDARILLA 212
Practice Address - Street 2:COMUNICAD BUENOS AIRES,
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-650-3711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005475103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist