MEDICARE: LISBET GUILLEN DE LA SIERRA 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
1	103K00000X	Behavior Analyst	1-25-81575	FL
2	106S00000X	Behavior Technician	RBT-20-123568	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	:	1659997872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISBET GUILLEN DE LA SIERRA BCBA

Provider Business Mailing Address
First Line	:	874 BREVARD CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-8118
Country	:	US
Telephone Number	:	786-381-1238
Fax Number	:

Provider Business Practice Location Address
First Line	:	874 BREVARD CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-8118
Country	:	US
Telephone Number	:	786-381-1238
Fax Number	:

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

Provider Enumeration Date	:	06/23/2020
Last Update Date	:	05/04/2026

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