Provider Demographics
NPI:1861195323
Name:RODRIGUEZ LORENZO, RITCHELIE
Entity type:Individual
Prefix:
First Name:RITCHELIE
Middle Name:
Last Name:RODRIGUEZ LORENZO
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 1:12784 SW 54TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5565
Mailing Address - Country:US
Mailing Address - Phone:786-458-2278
Mailing Address - Fax:
Practice Address - Street 1:12784 SW 54TH ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-5565
Practice Address - Country:US
Practice Address - Phone:786-458-2278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-243787106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician