Individual
LORENZO LORENZO-LUACES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
4401 CENTRAL AVE, INDIANAPOLIS, IN 46205-1822
(317) 923-2333
Mailing address
1101 E 10TH ST, BLOOMINGTON, IN 47405-7007
(812) 856-0866
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20043407A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20043407A
INDIANA STATE PSYCHOLOGY BOARD
IN
Enumeration date
04/27/2021
Last updated
04/27/2021
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