Provider Demographics
NPI:1952504482
Name:ALONSO, LECSYS L (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:LECSYS
Middle Name:L
Last Name:ALONSO
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 1:6391 SW 34TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4924
Mailing Address - Country:US
Mailing Address - Phone:305-979-3003
Mailing Address - Fax:
Practice Address - Street 1:2141 SW 1ST ST STE 103
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1695
Practice Address - Country:US
Practice Address - Phone:305-644-6024
Practice Address - Fax:305-644-6025
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FL9120101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2365Medicaid