Healthcare Provider Details

I. General information

NPI: 1801336201
Provider Name (Legal Business Name): LISA CICETTI PSYD.,LMHC.,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2017
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 OSCEOLA DR
WEST PALM BEACH FL
33409-5000
US

IV. Provider business mailing address

1111 HYPOLUXO RD 207
LANTANA FL
33462-4271
US

V. Phone/Fax

Practice location:
  • Phone: 561-530-7489
  • Fax:
Mailing address:
  • Phone: 561-530-7489
  • Fax: 954-856-2904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY7715
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME0075481
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY7715
License Number StateFL

VIII. Authorized Official

Name: VERONICA HERNANDEZ
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 954-203-3584