MEDICARE: KAREN LORENA LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1043187933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAREN LORENA LLC

Provider Business Mailing Address
First Line	:	26150 OLD 41 RD UNIT 368162
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34136-2597
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	26150 OLD 41 RD UNIT 368162
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34136-2597
Country	:	US
Telephone Number	:	239-910-2319
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KAREN LORENA RODRIGUEZ
Credential	:	NP
Telephone Number	:	239-910-2319

Provider Enumeration Date	:	10/23/2025
Last Update Date	:	10/23/2025

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