Provider Demographics
NPI:1043309073
Name:LORENTZ, VICKEY LYNN (LCSW)
Entity type:Individual
Prefix:MISS
First Name:VICKEY
Middle Name:LYNN
Last Name:LORENTZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4212 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5319
Mailing Address - Country:US
Mailing Address - Phone:602-263-1518
Mailing Address - Fax:602-263-1625
Practice Address - Street 1:4212 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5319
Practice Address - Country:US
Practice Address - Phone:602-263-1518
Practice Address - Fax:602-263-1625
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-38831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ742545Medicaid
AZ8HBC79 PART BMedicare ID - Type Unspecified
AZ742545Medicaid
AZ_P74854Medicare UPIN