Provider Demographics
NPI:1851914287
Name:GARZON, LISSETTE (MH)
Entity Type:Individual
Prefix:
First Name:LISSETTE
Middle Name:
Last Name:GARZON
Suffix:
Gender:F
Credentials:MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10955 NW 12TH DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-8204
Mailing Address - Country:US
Mailing Address - Phone:954-600-1728
Mailing Address - Fax:
Practice Address - Street 1:10955 NW 12TH DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-8204
Practice Address - Country:US
Practice Address - Phone:954-600-1728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker