MEDICARE: KIARA C LLERENA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1386411809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIARA C LLERENA

Provider Business Mailing Address
First Line	:	5723 KEATON SPRINGS DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33811-1884
Country	:	US
Telephone Number	:	201-899-8286
Fax Number	:

Provider Business Practice Location Address
First Line	:	5723 KEATON SPRINGS DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33811-1884
Country	:	US
Telephone Number	:	201-899-8286
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2023
Last Update Date	:	12/18/2023

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Directions to “ KIARA C LLERENA ” Practice Location

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