Provider Demographics
NPI:1497893564
Name:CERPA, LYDIA C (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LYDIA
Middle Name:C
Last Name:CERPA
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 1:905 BRICKELL BAY DR
Mailing Address - Street 2:SUITE 228
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2923
Mailing Address - Country:US
Mailing Address - Phone:305-335-6455
Mailing Address - Fax:
Practice Address - Street 1:905 BRICKELL BAY DR
Practice Address - Street 2:SUITE 228
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-2923
Practice Address - Country:US
Practice Address - Phone:305-335-6455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 0002171174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist