Healthcare Provider Details

I. General information

NPI: 1699118463
Provider Name (Legal Business Name): LIZETTE LAME JIMENEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 GARDEN PLZ
ORLANDO FL
32803-4212
US

IV. Provider business mailing address

13800 VETERANS WAY
ORLANDO FL
32827-7401
US

V. Phone/Fax

Practice location:
  • Phone: 407-894-8894
  • Fax:
Mailing address:
  • Phone: 407-580-2258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW11269
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: