Provider Demographics
NPI:1942770391
Name:TOLEDO, LISMERYS M (LCSW)
Entity Type:Individual
Prefix:
First Name:LISMERYS
Middle Name:M
Last Name:TOLEDO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LISMERYS
Other - Middle Name:M
Other - Last Name:PEREA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3580 MYSTIC POINTE DR STE 107
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2554
Mailing Address - Country:US
Mailing Address - Phone:305-423-9671
Mailing Address - Fax:
Practice Address - Street 1:3580 MYSTIC POINTE DR STE 107
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2554
Practice Address - Country:US
Practice Address - Phone:305-423-9671
Practice Address - Fax:786-408-5977
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW158661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical