Provider Demographics
NPI:1205907334
Name:ALCARAZ, LIZZETTE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LIZZETTE
Middle Name:
Last Name:ALCARAZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 NORRIS PL
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-3431
Mailing Address - Country:US
Mailing Address - Phone:407-482-0541
Mailing Address - Fax:407-695-1370
Practice Address - Street 1:5390 HOFFNER AVE
Practice Address - Street 2:SUITE F
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-2458
Practice Address - Country:US
Practice Address - Phone:407-482-0541
Practice Address - Fax:407-695-1370
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA-3421235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8255882OtherCIGNA HEALTHCARE