Healthcare Provider Details

I. General information

NPI: 1013799212
Provider Name (Legal Business Name): PAUL ANTHONY CISNEROS LMHC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 10/23/2023
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 TORPOINT GATE RD
LONGWOOD FL
32779-5625
US

IV. Provider business mailing address

267 TORPOINT GATE RD
LONGWOOD FL
32779-5625
US

V. Phone/Fax

Practice location:
  • Phone: 813-382-2236
  • Fax:
Mailing address:
  • Phone: 813-382-2236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH18371
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: