Provider Demographics
NPI:1720886351
Name:FUNDORA, LIHANNA
Entity type:Individual
Prefix:
First Name:LIHANNA
Middle Name:
Last Name:FUNDORA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:LIHANNA
Other - Middle Name:
Other - Last Name:FUNDORA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:710 E 9TH ST APT 105
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4571
Mailing Address - Country:US
Mailing Address - Phone:786-830-2984
Mailing Address - Fax:
Practice Address - Street 1:710 E 9TH ST APT 105
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4571
Practice Address - Country:US
Practice Address - Phone:786-830-2984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-07
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA20240617269155103TP2701X
104100000X, 172V00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No172V00000XOther Service ProvidersCommunity Health Worker