1922854348 NPI number — MISS MADELEINE GRACE LORENZEN LMSW

Table of content: MISS MADELEINE GRACE LORENZEN LMSW (NPI 1922854348)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922854348 NPI number — MISS MADELEINE GRACE LORENZEN LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LORENZEN
Provider First Name:
MADELEINE
Provider Middle Name:
GRACE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922854348
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1419 MERMAID AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11224-2615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-210-3110
Provider Business Mailing Address Fax Number:
718-333-0865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1419 MERMAID AVE
Provider Second Line Business Practice Location Address:
GROUND LEVEL
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11224-2615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-210-3110
Provider Business Practice Location Address Fax Number:
718-333-0865
Provider Enumeration Date:
04/26/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  122851 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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