Provider Demographics
NPI:1750362257
Name:GONZALEZ, LISSETTE L (PH D LMHC)
Entity type:Individual
Prefix:DR
First Name:LISSETTE
Middle Name:L
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PH D LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7235 CORAL WAY
Mailing Address - Street 2:SUITE 211
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1466
Mailing Address - Country:US
Mailing Address - Phone:305-264-5008
Mailing Address - Fax:305-264-5424
Practice Address - Street 1:7235 CORAL WAY
Practice Address - Street 2:SUITE 211
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1466
Practice Address - Country:US
Practice Address - Phone:305-264-5008
Practice Address - Fax:305-264-5424
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 2517101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health