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General NPI Number Information
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NPI Number | 1578003182
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Entity Type | Individual
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Provider Name | LISSETTE ALVAREZ GONZALEZ
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Gender | Female
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Dates
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Enumeration Date | 03/01/2017
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 18522 SW 136TH CT
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City | MIAMI
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State | FL
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Zip | 33177-6283
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Country | US
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Telephone | 305-416-8189
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Fax | 561-336-0254
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Provider Business Mailing Address
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Address Line | 230 CANAL ST APT 202
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City | MIAMI SPRINGS
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State | FL
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Zip | 33166-4456
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Country | US
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Telephone | 305-416-8189
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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 | MH21431
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BCBA1-23-70484
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License Number State | FL
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