Provider Demographics
NPI:1235753054
Name:LILLY1CONSULTING CORP
Entity Type:Organization
Organization Name:LILLY1CONSULTING CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:786-417-1922
Mailing Address - Street 1:18181 NE 31ST CT APT 2503
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2679
Mailing Address - Country:US
Mailing Address - Phone:786-417-1922
Mailing Address - Fax:
Practice Address - Street 1:18181 NE 31ST CT APT 2503
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-2679
Practice Address - Country:US
Practice Address - Phone:786-417-1922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health