Provider Demographics
NPI:1962798967
Name:LOZADA, VIVIAN ELENA (LMHC)
Entity type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:ELENA
Last Name:LOZADA
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 1:9135 FONTAINEBLEAU BLVD
Mailing Address - Street 2:UNIT # 8
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4386
Mailing Address - Country:US
Mailing Address - Phone:786-271-6739
Mailing Address - Fax:
Practice Address - Street 1:9135 FONTAINEBLEAU BLVD
Practice Address - Street 2:UNIT # 8
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4386
Practice Address - Country:US
Practice Address - Phone:786-271-6739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FLMH6138101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004294200Medicaid