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General NPI Number Information
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NPI Number | 1023301298
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Entity Type | Individual
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Provider Name | OMAYRA LIZARDO LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/22/2011
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 3105 NW 107TH AVE STE 400-B10
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City | DORAL
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State | FL
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Zip | 33172-2185
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Country | US
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Telephone | 754-207-7915
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Fax |
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Provider Business Mailing Address
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Address Line | 2114 N FLAMINGO RD # 1335
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-3501
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Country | US
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Telephone | 754-207-7915
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW9141
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License Number State | FL
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