Provider Demographics
NPI:1275732240
Name:RATTINER PADILLA, LISA ROSE
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ROSE
Last Name:RATTINER PADILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8541 BOCA GLADES BLVD W APT D
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4085
Mailing Address - Country:US
Mailing Address - Phone:516-455-7095
Mailing Address - Fax:
Practice Address - Street 1:8541 BOCA GLADES BLVD W APT D
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4085
Practice Address - Country:US
Practice Address - Phone:516-455-7095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
FLSW173471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health