Healthcare Provider Details

I. General information

NPI: 1467199158
Provider Name (Legal Business Name): LISHA ROSERIE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 BRICKELL AVE STE 400
MIAMI FL
33131-3135
US

IV. Provider business mailing address

1110 BRICKELL AVE STE 400
MIAMI FL
33131-3135
US

V. Phone/Fax

Practice location:
  • Phone: 954-520-7168
  • Fax:
Mailing address:
  • Phone: 954-520-7168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT4361
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number21284
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: