Provider Demographics
NPI:1477965903
Name:DELHOMME, LISEANNE
Entity Type:Individual
Prefix:
First Name:LISEANNE
Middle Name:
Last Name:DELHOMME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4988 DAVIS RD APT 208
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-5562
Mailing Address - Country:US
Mailing Address - Phone:561-932-3651
Mailing Address - Fax:
Practice Address - Street 1:4988 DAVIS RD APT 208
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-5562
Practice Address - Country:US
Practice Address - Phone:561-932-3651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FL20527101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health