Provider Demographics
NPI:1780621201
Name:AVEROFF, LISA (LMHC)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:AVEROFF
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 1:10051 MONTAGUE ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1855
Mailing Address - Country:US
Mailing Address - Phone:727-455-9290
Mailing Address - Fax:813-510-3694
Practice Address - Street 1:10051 MONTAGUE ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1855
Practice Address - Country:US
Practice Address - Phone:727-455-9290
Practice Address - Fax:813-510-3694
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4617101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ000LOtherBLUE CROSS
FLZ000LOtherBLUE CROSS