MEDICARE: DANIELLA MARIA RUSSO-LOLAS

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	106S00000X	Behavior Technician	RBT-26-522392	FL

General Provider Information

NPI Number	:	1194664888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLA MARIA RUSSO-LOLAS

Provider Business Mailing Address
First Line	:	7356 SW 158TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-3307
Country	:	US
Telephone Number	:	786-630-7713
Fax Number	:

Provider Business Practice Location Address
First Line	:	7356 SW 158TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-3307
Country	:	US
Telephone Number	:	786-630-7713
Fax Number	:

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

Provider Enumeration Date	:	03/26/2026
Last Update Date	:	03/26/2026

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Directions to “ DANIELLA MARIA RUSSO-LOLAS ” Practice Location

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