Provider Demographics
NPI:1194450437
Name:ALCANTARA PEREIRA, LORENA
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:ALCANTARA PEREIRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 OAK CREEK CIR UNIT 201
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-6588
Mailing Address - Country:US
Mailing Address - Phone:979-255-4152
Mailing Address - Fax:
Practice Address - Street 1:1909 OAK CREEK CIR UNIT 201
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-6588
Practice Address - Country:US
Practice Address - Phone:979-255-4152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TB0200X
FL0-24-15571106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79365050-1OtherOBAMACARE/ OSCAR HEALTH INSURANCE