Provider Demographics
NPI:1437478062
Name:GEHRKE, LISA ROSE (HS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ROSE
Last Name:GEHRKE
Suffix:
Gender:F
Credentials:HS
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ROSE
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HS
Mailing Address - Street 1:11031 NE 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-7182
Mailing Address - Country:US
Mailing Address - Phone:305-398-6100
Mailing Address - Fax:305-757-4465
Practice Address - Street 1:220 SW 2ND ST
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-4611
Practice Address - Country:US
Practice Address - Phone:954-941-9828
Practice Address - Fax:954-941-9808
Is Sole Proprietor?:No
Enumeration Date:2010-05-21
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor