Healthcare Provider Details

I. General information

NPI: 1811490162
Provider Name (Legal Business Name): LIA SARAIVA GRIMES M.A., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LIA SARAIVA FELIX

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1284 DEVIN OAKS CT
LAKELAND FL
33811-2383
US

IV. Provider business mailing address

PO BOX 6553
LAKELAND FL
33807-6553
US

V. Phone/Fax

Practice location:
  • Phone: 863-602-0698
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-56441
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-19-10164
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: