Healthcare Provider Details

I. General information

NPI: 1376839027
Provider Name (Legal Business Name): CAROLINA GRACE LORENZO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 CALLE PAVA
SANTA FE NM
87505-6319
US

IV. Provider business mailing address

748 60TH ST
OAKLAND CA
94609-1422
US

V. Phone/Fax

Practice location:
  • Phone: 415-572-8983
  • Fax:
Mailing address:
  • Phone: 415-572-8983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2026-0146
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: