Healthcare Provider Details

I. General information

NPI: 1114550316
Provider Name (Legal Business Name): LIZT LTM CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2020
Last Update Date: 01/18/2025
Certification Date: 01/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 CARIBBEAN BLVD
CUTLER BAY FL
33189-1521
US

IV. Provider business mailing address

100 NE 15TH ST STE 204
HOMESTEAD FL
33030-4576
US

V. Phone/Fax

Practice location:
  • Phone: 305-968-3011
  • Fax:
Mailing address:
  • Phone: 305-968-3011
  • Fax: 786-701-8538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: TAMARA COLLADO
Title or Position: LEAD ANALYST
Credential: BCBA
Phone: 305-968-3011