MEDICARE: MRS. LIZETTE M MEJIAS

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
2	103K00000X	Behavior Analyst	1-23-67133	FL

General Provider Information

NPI Number	:	1205462520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LIZETTE M MEJIAS

Provider Business Mailing Address
First Line	:	12215 30TH ST E
Second Line	:
City	:	PARRISH
State	:	FL
Zip	:	34219-1608
Country	:	US
Telephone Number	:	908-397-8792
Fax Number	:

Provider Business Practice Location Address
First Line	:	6421 N FLORIDA AVE STE D-1458
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-6007
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

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

Provider Enumeration Date	:	03/18/2020
Last Update Date	:	03/10/2026

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