Provider Demographics
NPI:1376519264
Name:LORENZEN, MARK EUGENE (MSW)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:EUGENE
Last Name:LORENZEN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5633 ORCA DR NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-1983
Mailing Address - Country:US
Mailing Address - Phone:253-952-3072
Mailing Address - Fax:
Practice Address - Street 1:2DN & LIGGETT ST. BLDING 2006A, MCHJ-DA
Practice Address - Street 2:ARMY SUBSTANCE ABUSE PROGRAM/MAMC
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-967-1452
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01803104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker