MEDICARE: MS. LISA AVEROFF LMHC

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	101YM0800X	Mental Health Counselor	MH4617	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z000L	OTHER	FL	BLUE CROSS

General Provider Information

NPI Number	:	1780621201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA AVEROFF LMHC

Provider Business Mailing Address
First Line	:	10051 MONTAGUE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-1855
Country	:	US
Telephone Number	:	727-455-9290
Fax Number	:	813-510-3694

Provider Business Practice Location Address
First Line	:	10051 MONTAGUE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-1855
Country	:	US
Telephone Number	:	727-455-9290
Fax Number	:	813-510-3694

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	04/11/2014

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