Healthcare Provider Details

I. General information

NPI: 1790300994
Provider Name (Legal Business Name): DEBORAH LEAH DRIZIN LMHC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 MYSTIC POINTE DR # 106
AVENTURA FL
33180-2554
US

IV. Provider business mailing address

3580 MYSTIC POINTE DR # 106
AVENTURA FL
33180-2554
US

V. Phone/Fax

Practice location:
  • Phone: 786-309-1865
  • Fax:
Mailing address:
  • Phone: 786-309-1865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number16866
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3681
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: