Healthcare Provider Details

I. General information

NPI: 1114642550
Provider Name (Legal Business Name): LISA M ARANGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2022
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2906 S FALKENBURG RD
RIVERVIEW FL
33578-2554
US

IV. Provider business mailing address

46 WASHINGTON AVE STE 1
SUFFERN NY
10901-5608
US

V. Phone/Fax

Practice location:
  • Phone: 877-276-0626
  • Fax:
Mailing address:
  • Phone: 877-276-0626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-17097
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: