Provider Demographics
NPI:1831076983
Name:MIRANDA LORENZO, IVELINDA (LCDA)
Entity type:Individual
Prefix:
First Name:IVELINDA
Middle Name:
Last Name:MIRANDA LORENZO
Suffix:
Gender:F
Credentials:LCDA
Other - Prefix:MRS
Other - First Name:IVELINDA
Other - Middle Name:
Other - Last Name:MIRANDA LORENZO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCDA
Mailing Address - Street 1:BDA POLVORIN
Mailing Address - Street 2:CALLE 11 APT 6
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736
Mailing Address - Country:US
Mailing Address - Phone:787-388-6320
Mailing Address - Fax:
Practice Address - Street 1:BDA POLVORIN
Practice Address - Street 2:CALLE 11 APT 6
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-388-6320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR154321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical