Healthcare Provider Details

I. General information

NPI: 1780841908
Provider Name (Legal Business Name): LISA SAPONARO PHD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7820 PETERS RD STE E100
PLANTATION FL
33324-4019
US

IV. Provider business mailing address

1469 NW 129TH WAY
SUNRISE FL
33323-2984
US

V. Phone/Fax

Practice location:
  • Phone: 954-577-0095
  • Fax: 954-423-0901
Mailing address:
  • Phone: 954-560-9567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: LISA SAPONARO
Title or Position: OWNER
Credential: PHD
Phone: 954-560-9567