Provider Demographics
NPI:1356239842
Name:OLIVERA, LIDISBETH
Entity type:Individual
Prefix:
First Name:LIDISBETH
Middle Name:
Last Name:OLIVERA
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 1:3105 FRENCH AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3720
Mailing Address - Country:US
Mailing Address - Phone:561-572-5550
Mailing Address - Fax:
Practice Address - Street 1:3105 FRENCH AVE
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-3720
Practice Address - Country:US
Practice Address - Phone:561-572-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLO613852469000106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician