Provider Demographics
NPI:1558728840
Name:BRETON, LILIANA (MA)
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:BRETON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 WESTHALL LN STE 118
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7451
Mailing Address - Country:US
Mailing Address - Phone:617-379-0496
Mailing Address - Fax:
Practice Address - Street 1:725 PRIMERA BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2125
Practice Address - Country:US
Practice Address - Phone:407-732-7266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 13210101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health