Provider Demographics
NPI:1922571074
Name:SHAPIRO, ALICE LISA (LMHC)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:LISA
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17720 N BAY RD APT 1204
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2894
Mailing Address - Country:US
Mailing Address - Phone:917-853-3401
Mailing Address - Fax:
Practice Address - Street 1:2312 WILTON DR
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1249
Practice Address - Country:US
Practice Address - Phone:954-764-5150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15931101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health