Healthcare Provider Details

I. General information

NPI: 1235455726
Provider Name (Legal Business Name): LORI LYNN LORENZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2010
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14014 ROUTE 31
ALBION NY
14411-9301
US

IV. Provider business mailing address

2449 EAGLE HARBOR WATERPORT RD
ALBION NY
14411-9050
US

V. Phone/Fax

Practice location:
  • Phone: 585-589-7066
  • Fax:
Mailing address:
  • Phone: 585-283-4083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0764831
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: