Provider Demographics
NPI:1083404370
Name:SOSA SANCHEZ, LORENA M
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:M
Last Name:SOSA SANCHEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 SW 122ND AVE APT 524
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7339
Mailing Address - Country:US
Mailing Address - Phone:786-695-8229
Mailing Address - Fax:
Practice Address - Street 1:2075 SW 122ND AVE APT 524
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-7339
Practice Address - Country:US
Practice Address - Phone:786-695-8229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-431787106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty