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General NPI Number Information
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NPI Number | 1225489180
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Entity Type | Individual
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Provider Name | VIVIAN BLANCO LEZCANO
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Gender | Female
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Dates
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Enumeration Date | 06/22/2016
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Last Update Date | 02/23/2022
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Provider Practice Location Address
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Address Line | 12150 SW 128TH CT STE 228
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City | MIAMI
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State | FL
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Zip | 33186-4674
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Country | US
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Telephone | 786-712-7151
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Fax |
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Provider Business Mailing Address
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Address Line | 9260 SW 149TH CT
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City | MIAMI
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State | FL
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Zip | 33196-1675
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Country | US
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Telephone | 786-319-0748
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH16426
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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