Healthcare Provider Details

I. General information

NPI: 1669215406
Provider Name (Legal Business Name): LILIANA VICTORIA MARIE CUTCHEN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LILIANA BROADWAY

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20311 CENTRAL AVE W
BLOUNTSTOWN FL
32424-1947
US

IV. Provider business mailing address

463 MELROSE WAY
PANAMA CITY BEACH FL
32413-2269
US

V. Phone/Fax

Practice location:
  • Phone: 850-674-8888
  • Fax:
Mailing address:
  • Phone: 850-274-7785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23334
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: