Provider Demographics
NPI:1346447059
Name:CERVERA, GRISELL (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:GRISELL
Middle Name:
Last Name:CERVERA
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5067 SW 165TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5171
Mailing Address - Country:US
Mailing Address - Phone:305-222-8982
Mailing Address - Fax:
Practice Address - Street 1:3899 NW 7TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5551
Practice Address - Country:US
Practice Address - Phone:305-644-0622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7115101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health