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NPI Code Detail

MEDICARE: LISETTE LACOSTA BCBA

MEDICARE: LISETTE LACOSTA BCBA
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
1103K00000XBehavior Analyst1-19-38810

Other Identifiers

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

General Provider Information

NPI Number : 1174892053
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISETTE LACOSTA BCBA
Provider Business Mailing Address
First Line : 7735 NW 48TH ST STE 110
Second Line :
City : DORAL
State : FL
Zip : 33166-5547
Country : US
Telephone Number : 786-860-5161
Fax Number : 855-710-7707
Provider Business Practice Location Address
First Line : 657 SOUTH DR STE 403
Second Line :
City : MIAMI SPRINGS
State : FL
Zip : 33166-5926
Country : US
Telephone Number : 786-860-5161
Fax Number : 855-710-7707
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2011
Last Update Date : 04/25/2023

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Directions to “ LISETTE LACOSTA BCBA” Practice Location

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