Provider Demographics
NPI:1447810023
Name:CISNEROS, CRYSTAL (LMFT-QS)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:LMFT-QS
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:FERRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9940 NW 9TH STREET CIR APT 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5106
Mailing Address - Country:US
Mailing Address - Phone:786-999-2266
Mailing Address - Fax:
Practice Address - Street 1:11200 SW 8TH ST
Practice Address - Street 2:SHC 270
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33199-1436
Practice Address - Country:US
Practice Address - Phone:305-348-2277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT2461106H00000X
FLMT3986106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist