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NPI Code Detail

MEDICARE: LISSETTE LUCES TENIA

MEDICARE: LISSETTE LUCES TENIA
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
1106S00000XBehavior Technician
2103K00000XBehavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720544174
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISSETTE LUCES TENIA
Provider Business Mailing Address
First Line : 7440 RIPPLEPOINTE WAY
Second Line :
City : WINDERMERE
State : FL
Zip : 34786-5717
Country : US
Telephone Number : 321-278-3666
Fax Number :
Provider Business Practice Location Address
First Line : 7600 DR PHILLIPS BLVD STE 72
Second Line :
City : ORLANDO
State : FL
Zip : 32819-7238
Country : US
Telephone Number : 407-730-5969
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2019
Last Update Date : 12/08/2022

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Directions to “ LISSETTE LUCES TENIA ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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