Provider Demographics
NPI:1295620797
Name:MONTANO HERRERA, LORENA
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:MONTANO HERRERA
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 1:22319 BLANCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-1955
Mailing Address - Country:US
Mailing Address - Phone:786-771-3920
Mailing Address - Fax:786-771-3920
Practice Address - Street 1:22319 BLANCHARD AVE
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-1955
Practice Address - Country:US
Practice Address - Phone:786-771-3920
Practice Address - Fax:786-771-3920
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25441227106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician