=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598904443
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY C LAMAZARES LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2009
-----------------------------------------------------
Last Update Date | 01/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3414 W 84TH ST STE 100
-----------------------------------------------------
City | HIALEAH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33018-4932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-313-3558
-----------------------------------------------------
Fax | 786-360-5803
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12231 SW 94TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-1913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-962-0366
-----------------------------------------------------
Fax | 305-271-9926
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH7355
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------