Provider Demographics
NPI:1558656256
Name:LUZARDO, DORINDA
Entity Type:Individual
Prefix:
First Name:DORINDA
Middle Name:
Last Name:LUZARDO
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 1:15165 NW 77TH AVE STE 1002
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-7825
Mailing Address - Country:US
Mailing Address - Phone:305-828-5276
Mailing Address - Fax:
Practice Address - Street 1:15165 NW 77TH AVE STE 1002
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-7825
Practice Address - Country:US
Practice Address - Phone:305-828-5276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician