Healthcare Provider Details

I. General information

NPI: 1134777055
Provider Name (Legal Business Name): LIANA CHAMBLISS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NE SPANISH RIVER BLVD STE 31
BOCA RATON FL
33431-4517
US

IV. Provider business mailing address

4620 N STATE ROAD 7 STE 3
LAUDERDALE LAKES FL
33319-5884
US

V. Phone/Fax

Practice location:
  • Phone: 561-563-3738
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-24-1538
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-99463
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: