Provider Demographics
NPI:1285973354
Name:MESTRE-LOPEZ, LILLIAN (LMHC;CCM;CPHM)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:MESTRE-LOPEZ
Suffix:
Gender:F
Credentials:LMHC;CCM;CPHM
Other - Prefix:
Other - First Name:LILY
Other - Middle Name:
Other - Last Name:MESTRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC; CCM;CPHM
Mailing Address - Street 1:901 CRANDON BLVD
Mailing Address - Street 2:
Mailing Address - City:KEY BISCAYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149-2752
Mailing Address - Country:US
Mailing Address - Phone:305-710-3738
Mailing Address - Fax:
Practice Address - Street 1:901 CRANDON BLVD
Practice Address - Street 2:
Practice Address - City:KEY BISCAYNE
Practice Address - State:FL
Practice Address - Zip Code:33149-2752
Practice Address - Country:US
Practice Address - Phone:305-710-3738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6699101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health