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General NPI Number Information
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NPI Number | 1578955563
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Entity Type | Organization
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Legal Business Name | LISA CICETTI PSYD., LMHC INC
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Dates
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Enumeration Date | 02/27/2015
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Last Update Date | 03/06/2015
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Provider Practice Location Address
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Address Line | 555 HERITAGE DR. STE 110
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City | JUPITER
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State | FL
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Zip | 33458
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Country | US
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Telephone | 561-734-6118
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 N CONGRESS AVE STE 208
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City | BOYNTON BEACH
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State | FL
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Zip | 33426
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Country | US
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Telephone | 561-734-6118
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | CARRIE ALLINGTON
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Credential | B.A.
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Telephone | 561-734-6118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | FL
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