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NPI Code Detail

MEDICARE: LISA CICETTI PSY.D.,L.M.H.C.

MEDICARE: LISA CICETTI PSY.D.,L.M.H.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorMH 6095FL
2103T00000XPsychologist
3103TB0200XCognitive & Behavioral PsychologistPY 7715FL
4103G00000XClinical NeuropsychologistPY 7715FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316102114
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA CICETTI PSY.D.,L.M.H.C.
Provider Business Mailing Address
First Line : 125 NEPTUNE DR
Second Line :
City : HYPOLUXO
State : FL
Zip : 33462-6019
Country : US
Telephone Number : 561-734-6118
Fax Number : 561-369-3275
Provider Business Practice Location Address
First Line : 2500 QUANTUM LAKES DR STE 203
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33426-8323
Country : US
Telephone Number : 561-502-1992
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2008
Last Update Date : 01/20/2023

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