Individual provider Active NPI

Omayra Lizardo, LCSW

  • Clinical Social Worker
  • Doral, FL
National Provider Identifier
1023301298
Registry record updated Jan 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW9141 Issued in FL
Practice address
3105 NW 107TH Ave Ste 400-B10
Doral, FL 33172-2185
Phone
(754) 207-7915
NPI assigned
May 22, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 6, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X SW9141 FL Primary

Addresses

Primary practice location

3105 NW 107TH Ave Ste 400-B10
Doral, FL 33172-2185

Mailing address

2114 N Flamingo Rd # 1335
Pembroke Pines, FL 33028-3501
Phone (754) 207-7915

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111019000767 FL Practitioner - Clinical Social Worker 7719159615 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Senior Living Memory Health IncGroup PAC ID 7517480577, 113 clinicians

Practice addresses (Care Compare)

16025 Emerald Estates Dr
Weston, FL 33331-6130
Phone (786) 414-6666

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SW9141FLMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Mtca Psychological Services P.a. CurrentSince Jan 30, 2025 Accepting new patients
Senior Living Memory Health, Inc. CurrentSince May 1, 2025 Accepting new patients
Diab Medical Group PastSince Jul 1, 2022 Accepting new patients

Locations

2000 Lowson Blvd
Delray Beach, FL 33445
Phone (561) 454-2000

7091 Atlantic Ave
Delray Beach, FL 33446
Phone (561) 558-2149

16853 NE 2nd Ave
Ste 304
North Miami Beach, FL 33162
Phone (954) 907-1817

16853 NE 2nd Ave
Ste S304
North Miami Beach, FL 33162

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1306022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736121600000",
    "number": "1023301298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2114 N FLAMINGO RD # 1335",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330283501",
            "telephone_number": "754-207-7915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3105 NW 107TH AVE STE 400-B10",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331722185",
            "telephone_number": "754-207-7915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIZARDO",
        "first_name": "OMAYRA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-05-22",
        "last_updated": "2025-01-06",
        "certification_date": "2025-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW9141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Doral, FL

Sources for this page

Verify at the official NPI Registry.