Healthcare Provider Details

I. General information

NPI: 1386288629
Provider Name (Legal Business Name): LISHEYNA S HURVITZ M.A.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22715 CAMINO DEL MAR # 35
BOCA RATON FL
33433
US

IV. Provider business mailing address

22715 CAMINO DEL MAR # 35
BOCA RATON FL
33433
US

V. Phone/Fax

Practice location:
  • Phone: 561-922-7044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH460
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: