Provider Demographics
NPI:1982137949
Name:WIZELMAN, LAURA JUDITH (LMHC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JUDITH
Last Name:WIZELMAN
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 1:3500 MAGELLAN CCLE
Mailing Address - Street 2:UNIT 715
Mailing Address - City:AVE
Mailing Address - State:FL
Mailing Address - Zip Code:33180
Mailing Address - Country:US
Mailing Address - Phone:305-975-5541
Mailing Address - Fax:
Practice Address - Street 1:1380 NE MIAMI GARDENS DR
Practice Address - Street 2:ROOM 206
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179
Practice Address - Country:US
Practice Address - Phone:305-975-5541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 9582101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health