MEDICARE: MISS LISA KADISON BCBA

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	103K00000X	Behavior Analyst	11519528	FL

General Provider Information

NPI Number	:	1902269574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LISA KADISON BCBA

Provider Business Mailing Address
First Line	:	8525 HIDDEN RIVER PKWY
Second Line	:	UNIT 201
City	:	TAMPA
State	:	FL
Zip	:	33637-1150
Country	:	US
Telephone Number	:	813-957-7604
Fax Number	:

Provider Business Practice Location Address
First Line	:	8525 HIDDEN RIVER PKWY
Second Line	:	UNIT 201
City	:	TAMPA
State	:	FL
Zip	:	33637-1150
Country	:	US
Telephone Number	:	813-957-7604
Fax Number	:

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

Provider Enumeration Date	:	03/31/2016
Last Update Date	:	03/31/2016

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