Healthcare Provider Details

I. General information

NPI: 1356697874
Provider Name (Legal Business Name): LILIAM BERNAL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2012
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2163 W 73RD ST UNIT 4
HIALEAH FL
33016-5551
US

IV. Provider business mailing address

2163 W 73RD ST UNIT 4
HIALEAH FL
33016-5551
US

V. Phone/Fax

Practice location:
  • Phone: 305-825-3872
  • Fax: 305-825-3873
Mailing address:
  • Phone: 305-825-3872
  • Fax: 305-825-3873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW10815
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW10815
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: