Provider Demographics
NPI:1215341565
Name:CISNEROS, IMARA (LMHC)
Entity type:Individual
Prefix:
First Name:IMARA
Middle Name:
Last Name:CISNEROS
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 1:14842 SIPLIN RD
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5101
Mailing Address - Country:US
Mailing Address - Phone:407-770-8001
Mailing Address - Fax:
Practice Address - Street 1:14842 SIPLIN RD
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-5101
Practice Address - Country:US
Practice Address - Phone:407-770-8001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-15
Last Update Date:2022-11-16
Deactivation Date:2019-05-26
Deactivation Code:
Reactivation Date:2020-06-25
Provider Licenses
StateLicense IDTaxonomies
FLIMH 12320101Y00000X, 101YM0800X
FLMH19678101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor