Provider Demographics
NPI:1477829901
Name:MCDANIEL, LISA RIVERO (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:RIVERO
Last Name:MCDANIEL
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 1:648 SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5950
Mailing Address - Country:US
Mailing Address - Phone:786-499-3736
Mailing Address - Fax:786-353-2706
Practice Address - Street 1:2000 S DIXIE HWY
Practice Address - Street 2:SUITE104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2456
Practice Address - Country:US
Practice Address - Phone:786-499-3736
Practice Address - Fax:786-353-2706
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW67841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical