Healthcare Provider Details

I. General information

NPI: 1578739058
Provider Name (Legal Business Name): LISA ANNE HYLKEMA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W COLUMBIA ST
ORLANDO FL
32806-1006
US

IV. Provider business mailing address

100 W COLUMBIA ST
ORLANDO FL
32806-1006
US

V. Phone/Fax

Practice location:
  • Phone: 407-245-0014
  • Fax: 407-245-0015
Mailing address:
  • Phone: 407-245-0014
  • Fax: 407-245-0015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW7238
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: