Provider Demographics
NPI:1356063051
Name:CISNEROS, JOSEFINA J (LMHC)
Entity type:Individual
Prefix:
First Name:JOSEFINA
Middle Name:J
Last Name:CISNEROS
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 1:3150 EMERALD POINTE DR APT 108B
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-1339
Mailing Address - Country:US
Mailing Address - Phone:954-560-7510
Mailing Address - Fax:
Practice Address - Street 1:8030 PETERS RD STE D106
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-4038
Practice Address - Country:US
Practice Address - Phone:954-475-9503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14688101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health