Healthcare Provider Details

I. General information

NPI: 1841995149
Provider Name (Legal Business Name): LISET GOMEZ MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7448 ALOMA AVE STE 1
WINTER PARK FL
32792-9171
US

IV. Provider business mailing address

1048 AUGUST SKY DR
DELTONA FL
32738-9124
US

V. Phone/Fax

Practice location:
  • Phone: 321-295-0315
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number23-266050
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-2848482
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: