Active NPI
Lissette Collazo Maza, LCSW
- Clinical Social Worker
- Coral Gables, FL
National Provider Identifier
1700968690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SW8367
- Practice address
- 3850 W Flagler St
Coral Gables, FL 33134-1604 - Phone
- (305) 774-3334
- Fax
- (305) 475-2650
- NPI assigned
- Oct 19, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | |||
| Clinical Social Worker | 1041C0700X | SW8367 | FL | Primary |
Addresses
Primary practice location
3850 W Flagler St
Coral Gables, FL 33134-1604
Mailing address
11031 NE 6TH Ave
Miami, FL 33161-7182
Phone (305) 398-6100
Other practice location 1
8785 SW 165th Ave Ste 103
Miami, FL 33193-5827
Phone (786) 206-6500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW8367 | FL | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blissful Minds Wellness, LLC | Clinical | Current | Accepting new patients |
| Future Stars Behavioral Health Center LLC | Behavior Analyst | Current | Accepting new patients |
| The Healing Center of Miami Inc | Past | Accepting new patients |
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.
-
- Behavior Analyst
- West Palm Beach, FL
- NPI 1134014111
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Miami, FL
- NPI 1295856383
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522281600000",
"number": "1700968690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11031 NE 6TH AVE",
"city": "MIAMI",
"state": "FL",
"postal_code": "331617182",
"telephone_number": "305-398-6100",
"fax_number": "305-398-6099"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3850 W FLAGLER ST",
"city": "CORAL GABLES",
"state": "FL",
"postal_code": "331341604",
"telephone_number": "305-774-3334",
"fax_number": "305-475-2650"
}
],
"practiceLocations": [
{
"address_1": "8785 SW 165th Ave Ste 103",
"address_purpose": "LOCATION",
"city": "Miami",
"state": "FL",
"postal_code": "331935827",
"country_code": "US",
"telephone_number": "786-206-6500",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "COLLAZO MAZA",
"first_name": "LISSETTE",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-19",
"last_updated": "2018-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "SW8367",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coral Gables, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.