Provider Demographics
NPI:1225793854
Name:LISBOA, ELISE RIBAS (PHD IN PSYCHOLOGY)
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:RIBAS
Last Name:LISBOA
Suffix:
Gender:F
Credentials:PHD IN PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 RUBY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5698
Mailing Address - Country:US
Mailing Address - Phone:406-272-0147
Mailing Address - Fax:
Practice Address - Street 1:RUA DESEMBARGADOR FERREIRA FRANCA 40
Practice Address - Street 2:APARTMENT 174B
Practice Address - City:SAO PAULO
Practice Address - State:SAO PAULO
Practice Address - Zip Code:05446050
Practice Address - Country:BR
Practice Address - Phone:406-272-0147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-30205101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional