Provider Demographics
NPI:1669629671
Name:LIMA, MAYELIN (LCSW)
Entity Type:Individual
Prefix:
First Name:MAYELIN
Middle Name:
Last Name:LIMA
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 1:22790 SW 112TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33030-7602
Mailing Address - Country:US
Mailing Address - Phone:305-235-2616
Mailing Address - Fax:305-235-6178
Practice Address - Street 1:30722 SW 149TH PL
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-4412
Practice Address - Country:US
Practice Address - Phone:305-606-3313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW8980104100000X
FLSW 89801041C0700X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW8980OtherFLORIDA LICENSE NUMBER
FL001745500Medicaid
FL001745500Medicaid