Healthcare Provider Details

I. General information

NPI: 1518250166
Provider Name (Legal Business Name): KATHERINE LANZILLO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99198 OVERSEAS HWY STE 5
KEY LARGO FL
33037-2437
US

IV. Provider business mailing address

99198 OVERSEAS HWY STE 5
KEY LARGO FL
33037-2437
US

V. Phone/Fax

Practice location:
  • Phone: 305-434-7660
  • Fax: 305-451-8019
Mailing address:
  • Phone: 305-434-7660
  • Fax: 305-451-8019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH12712
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: