Healthcare Provider Details

I. General information

NPI: 1215124847
Provider Name (Legal Business Name): LISA CICETTI PSYD LMHC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 QUANTUM LAKES DR STE 203
BOYNTON BEACH FL
33426-8323
US

IV. Provider business mailing address

125 NEPTUNE DR
HYPOLUXO FL
33462-6019
US

V. Phone/Fax

Practice location:
  • Phone: 561-734-6118
  • Fax: 561-369-3275
Mailing address:
  • Phone: 561-734-6118
  • Fax: 561-369-3275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 6095
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY7715
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY 7715
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPY7715
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPY7715
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberPY7715
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberPY7715
License Number StateFL

VIII. Authorized Official

Name: DR. LISA CICETTI
Title or Position: OWNER
Credential: PSY.D., LMHC
Phone: 561-734-6118