MEDICARE: ADA LIDIA LLERENA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106E00000X	Assistant Behavior Analyst	RBT-23-284921	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083395990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADA LIDIA LLERENA

Provider Business Mailing Address
First Line	:	10380 SERENADE LN
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-3108
Country	:	US
Telephone Number	:	561-667-3844
Fax Number	:

Provider Business Practice Location Address
First Line	:	10380 SERENADE LN
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-3108
Country	:	US
Telephone Number	:	561-667-3844
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2023
Last Update Date	:	07/25/2023

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Directions to “ ADA LIDIA LLERENA ” Practice Location

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