MEDICARE: MS. LIANNE MERCEDES DELALUZ LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW 6322	FL

General Provider Information

NPI Number	:	1104031616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LIANNE MERCEDES DELALUZ LCSW

Provider Business Mailing Address
First Line	:	15475 SW 26 TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185
Country	:	US
Telephone Number	:	305-228-6260
Fax Number	:

Provider Business Practice Location Address
First Line	:	1951 NW 17TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-1547
Country	:	US
Telephone Number	:	305-774-9570
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	05/02/2016

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