Provider Demographics
NPI:1417725250
Name:KOBELEV, ALISA NICOLE
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:NICOLE
Last Name:KOBELEV
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 1:4212 LARGE LEAF LN
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-2654
Mailing Address - Country:US
Mailing Address - Phone:954-562-8914
Mailing Address - Fax:
Practice Address - Street 1:4212 LARGE LEAF LN
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-2654
Practice Address - Country:US
Practice Address - Phone:954-562-8914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician