Healthcare Provider Details

I. General information

NPI: 1225442361
Provider Name (Legal Business Name): LIZA JOSEPH LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 10/11/2021
Certification Date: 09/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 SW 27TH AVE
FORT LAUDERDALE FL
33312-2051
US

IV. Provider business mailing address

4740 N STATE ROAD 7
LAUDERDALE LAKES FL
33319-5839
US

V. Phone/Fax

Practice location:
  • Phone: 954-739-8066
  • Fax:
Mailing address:
  • Phone: 954-486-4005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH14461
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: