Healthcare Provider Details

I. General information

NPI: 1912846551
Provider Name (Legal Business Name): WILMARI LORENZO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 MAIN ST FL 400
SPRINGFIELD MA
01103-1063
US

IV. Provider business mailing address

22 SANTA BARBARA ST
SPRINGFIELD MA
01104-2115
US

V. Phone/Fax

Practice location:
  • Phone: 413-739-5572
  • Fax:
Mailing address:
  • Phone: 201-688-5434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: