Healthcare Provider Details

I. General information

NPI: 1548187677
Provider Name (Legal Business Name): CHARLIZE LORDI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 BURRSTONE DR
LEHIGH ACRES FL
33974-5622
US

IV. Provider business mailing address

4219 SAN FELICE LN
NORTH FORT MYERS FL
33917-2260
US

V. Phone/Fax

Practice location:
  • Phone: 786-925-0433
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-548838
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: