Provider Demographics
NPI:1457835183
Name:VILLALOBOS, LISANDRA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LISANDRA
Middle Name:
Last Name:VILLALOBOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14472 CLARKSON DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-6466
Mailing Address - Country:US
Mailing Address - Phone:787-373-8001
Mailing Address - Fax:
Practice Address - Street 1:14472 CLARKSON DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-6466
Practice Address - Country:US
Practice Address - Phone:787-373-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-19
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR144251041C0700X
FL196611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical