Healthcare Provider Details

I. General information

NPI: 1124831284
Provider Name (Legal Business Name): LISSETTE HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 SAVONA POINT CIR UNIT 208
CAPE CORAL FL
33914-3633
US

IV. Provider business mailing address

1738 SAVONA POINT CIR UNIT 208
CAPE CORAL FL
33914-3633
US

V. Phone/Fax

Practice location:
  • Phone: 786-491-8898
  • Fax:
Mailing address:
  • Phone: 786-491-8898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number24392107
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number24392107
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: