Provider Demographics
NPI:1942421342
Name:GIL, LISSETTE (LMHC, LSP)
Entity Type:Individual
Prefix:MRS
First Name:LISSETTE
Middle Name:
Last Name:GIL
Suffix:
Gender:F
Credentials:LMHC, LSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 SW 154TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4260
Mailing Address - Country:US
Mailing Address - Phone:305-903-3505
Mailing Address - Fax:305-228-0855
Practice Address - Street 1:10661 N KENDALL DR STE 228
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1556
Practice Address - Country:US
Practice Address - Phone:305-903-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-54264103K00000X
FLSS679103TS0200X
FL7915101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL760853500Medicaid