MEDICARE: CARMEN LENORGANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		CA
2	106H00000X	Marriage & Family Therapist	70518	CA

General Provider Information

NPI Number	:	1073782652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN LENORGANT

Provider Business Mailing Address
First Line	:	350 E AVENUE K4
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93535-4505
Country	:	US
Telephone Number	:	661-940-9094
Fax Number	:	661-951-1030

Provider Business Practice Location Address
First Line	:	350 E AVENUE K4
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93535-4505
Country	:	US
Telephone Number	:	661-940-9094
Fax Number	:	661-951-1030

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2008
Last Update Date	:	06/22/2012

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