Provider Demographics
NPI:1194176818
Name:PALACIO, LYEM
Entity type:Individual
Prefix:
First Name:LYEM
Middle Name:
Last Name:PALACIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9190 FONTAINEBLEAU BLVD
Mailing Address - Street 2:APT 402
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4383
Mailing Address - Country:US
Mailing Address - Phone:305-397-7340
Mailing Address - Fax:
Practice Address - Street 1:9190 FONTAINEBLEAU BLVD
Practice Address - Street 2:APT 402
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4383
Practice Address - Country:US
Practice Address - Phone:305-397-7340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004636103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling