Healthcare Provider Details

I. General information

NPI: 1508703422
Provider Name (Legal Business Name): ROBERTO LORENZO DSW, LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10814 72ND AVE STE 2
FOREST HILLS NY
11375-5301
US

IV. Provider business mailing address

10814 72ND AVE STE 2
FOREST HILLS NY
11375-5301
US

V. Phone/Fax

Practice location:
  • Phone: 347-392-4482
  • Fax:
Mailing address:
  • Phone: 347-392-4482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number128996
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: