Provider Demographics
NPI:1518381110
Name:ALEXANDER, LIZETTE (MS(EDS EQUIVALENT))
Entity Type:Individual
Prefix:
First Name:LIZETTE
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MS(EDS EQUIVALENT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5235 CONNER DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-3452
Mailing Address - Country:US
Mailing Address - Phone:813-493-0360
Mailing Address - Fax:
Practice Address - Street 1:3262 COVE BEND DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-2752
Practice Address - Country:US
Practice Address - Phone:813-443-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS00058103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool