Healthcare Provider Details

I. General information

NPI: 1316102114
Provider Name (Legal Business Name): LISA CICETTI PSY.D.,L.M.H.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
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: 561-502-1992
  • Fax:
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 TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPY 7715
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY 7715
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: