Doctor Name: | LISSETTE CARMONA DOKOUPIL |
NPI Number: | 1366699241 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW |
License Number: | ISW5090 |
Business Practice Address: | 15818 Sw Warfield Blvd Indiantown, FL - 349563513 |
Business Phone Number: | 5613138803 |
Business Fax Number: | 7725970412 |
Mailing Address: | 15818 Sw Warfield Blvd, INDIANTOWN |
State: | FL |
Postal Code: | 349563513 |
Phone Number: | 5613138803 |
Fax Number: | 7725970412 |
NPI Enumeration Date: | 08/22/2008 |
NPI Last Update Date: | 08/22/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | ISW5090 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |