Provider Demographics
NPI:1255810198
Name:MAMBRU, LIZZETTE (LMFT)
Entity type:Individual
Prefix:
First Name:LIZZETTE
Middle Name:
Last Name:MAMBRU
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12773 FOREST HILL BLVD STE 1211
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4760
Mailing Address - Country:US
Mailing Address - Phone:561-308-3465
Mailing Address - Fax:
Practice Address - Street 1:12773 FOREST HILL BLVD STE 1211
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4760
Practice Address - Country:US
Practice Address - Phone:561-308-3465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3554106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist