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General NPI Number Information
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NPI Number | 1386553618
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Entity Type | Individual
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Provider Name | ELIZABETH DE LA CARIDAD LICEA FORNARIS
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Gender | Female
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Dates
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Enumeration Date | 09/02/2026
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Last Update Date | 09/02/2026
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Provider Practice Location Address
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Address Line | 3722 CENTRAL AVE STE 6
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City | FORT MYERS
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State | FL
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Zip | 33901-8247
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Country | US
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Telephone | 239-848-5560
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Fax | 855-521-0661
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Provider Business Mailing Address
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Address Line | 1010 RIDGEWAY DR
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City | NORTH FORT MYERS
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State | FL
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Zip | 33903-4244
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Country | US
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Telephone | 239-309-3367
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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