Healthcare Provider Details

I. General information

NPI: 1942097092
Provider Name (Legal Business Name): L & L MENTAL MEDICAL & SOCIAL SERVICES CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 E 9TH ST APT 105
HIALEAH FL
33010-4571
US

IV. Provider business mailing address

710 E 9TH ST APT 105
HIALEAH FL
33010-4571
US

V. Phone/Fax

Practice location:
  • Phone: 786-830-2984
  • Fax:
Mailing address:
  • Phone: 786-830-2984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LIHANNA FUNDORA
Title or Position: CEO
Credential: PSYD
Phone: 786-830-2984