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General NPI Number Information
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NPI Number | 1396361838
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Entity Type | Individual
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Provider Name | LISY RIVERO GONZALEZ BCABA
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Gender | Female
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Dates
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Enumeration Date | 06/21/2020
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 814 SW 147TH AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-6126
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Country | US
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Telephone | 786-372-5051
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Fax |
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Provider Business Mailing Address
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Address Line | 814 SW 147TH AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-6126
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Country | US
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Telephone | 786-372-5051
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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 | RBT-20-116037
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | 0-25-15784
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License Number State | FL
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