=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356848840
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA B SALCEDO LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2018
-----------------------------------------------------
Last Update Date | 10/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8198 JOG ROAD STE 105
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33472-2900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-801-7577
-----------------------------------------------------
Fax | 866-757-5778
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6348 ETHAN DRIVE
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33467-8732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-801-7577
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW12415
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------