Healthcare Provider Details

I. General information

NPI: 1881996726
Provider Name (Legal Business Name): LISSETTE LLANES PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2010
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 NE 170TH ST
NORTH MIAMI BEACH FL
33160-3705
US

IV. Provider business mailing address

7620 BEACHVIEW DR
NORTH BAY VILLAGE FL
33141-4008
US

V. Phone/Fax

Practice location:
  • Phone: 561-790-1191
  • Fax:
Mailing address:
  • Phone: 786-797-4630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY6182
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: