MEDICARE: LISSETTE GARZON MH

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
1	104100000X	Social Worker
2	171M00000X	Case Manager/Care Coordinator	CBHCMS.0100679	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1851914287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISSETTE GARZON MH

Provider Business Mailing Address
First Line	:	10955 NW 12TH DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-8204
Country	:	US
Telephone Number	:	954-600-1728
Fax Number	:

Provider Business Practice Location Address
First Line	:	10211 W SAMPLE RD STE 212&214
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-3972
Country	:	US
Telephone Number	:	954-600-1728
Fax Number	:	786-364-7543

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2020
Last Update Date	:	04/11/2026

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