Individual provider Active NPI

Lissandra Sotolongo, LMHC

  • Mental Health Counselor
  • Hialeah, FL
National Provider Identifier
1104525278
Registry record updated Nov 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
20683 Issued in FL
Practice address
4175 W 20TH Ave
Hialeah, FL 33012-5874
Phone
(786) 228-6339
NPI assigned
Feb 28, 2023
Last updated
Nov 5, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 5, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 20683 FL Primary

Addresses

Primary practice location

4175 W 20TH Ave
Hialeah, FL 33012-5874

Mailing address

2940 SW 121St Ave
Miami, FL 33175-2314

Other practice location 1

2940 SW 121st Ave
Miami, FL 33175-2314
Phone (786) 228-6339

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
I20240108000031 FL Practitioner - Mental Health Counselor 7618328311 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
20683FLMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Citrus Health Network, Inc CurrentSince Jan 1, 2024 Accepting new patients
Citrus Health Network, Inc. CurrentSince Jan 1, 2024 Accepting new patients
Citrus Health Network Inc Current Accepting new patients

Locations

4175 W 20th Ave
Hialeah, FL 33012
Phone (305) 424-3030

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1677542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762300800000",
    "number": "1104525278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2940 SW 121ST AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331752314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4175 W 20TH AVE",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330125874",
            "telephone_number": "786-228-6339"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2940 SW 121st Ave",
            "address_purpose": "LOCATION",
            "city": "Miami",
            "state": "FL",
            "postal_code": "331752314",
            "country_code": "US",
            "telephone_number": "786-228-6339",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOTOLONGO",
        "first_name": "LISSANDRA",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-02-28",
        "last_updated": "2025-11-05",
        "certification_date": "2025-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "20683",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hialeah, FL

Sources for this page

Verify at the official NPI Registry.