Healthcare Provider Details

I. General information

NPI: 1205598869
Provider Name (Legal Business Name): LISNET ROSELL HERRADA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3221 NW 10TH TER STE 508
OAKLAND PARK FL
33309-5942
US

IV. Provider business mailing address

3221 NW 10TH TER STE 508
OAKLAND PARK FL
33309-5942
US

V. Phone/Fax

Practice location:
  • Phone: 305-833-8477
  • Fax: 305-468-6379
Mailing address:
  • Phone: 305-833-8477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-57369
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-70680
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: