Provider Demographics
NPI:1205245354
Name:ABDALLA, LISA (BCBA, RMHCI)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ABDALLA
Suffix:
Gender:F
Credentials:BCBA, RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 41825
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33743-1825
Mailing Address - Country:US
Mailing Address - Phone:727-742-8697
Mailing Address - Fax:800-981-5129
Practice Address - Street 1:600 1ST AVE N STE 234
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3609
Practice Address - Country:US
Practice Address - Phone:727-342-0535
Practice Address - Fax:800-981-5129
Is Sole Proprietor?:No
Enumeration Date:2014-08-02
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-03-1195103K00000X
FLIMH27131101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL689682196Medicaid
FL689682196Medicaid