Provider Demographics
NPI:1821843483
Name:MENOCAL, LIANISEL
Entity Type:Individual
Prefix:
First Name:LIANISEL
Middle Name:
Last Name:MENOCAL
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 1:7601 RAMONA ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-2534
Mailing Address - Country:US
Mailing Address - Phone:754-215-7059
Mailing Address - Fax:
Practice Address - Street 1:7601 RAMONA ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-2534
Practice Address - Country:US
Practice Address - Phone:754-215-7059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-339594106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician