Provider Demographics
NPI:1295344331
Name:ACOSTA IMAS, LAZARA ISMARAY (RBT)
Entity type:Individual
Prefix:
First Name:LAZARA ISMARAY
Middle Name:
Last Name:ACOSTA IMAS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 HIALEAH DR APT 216
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5260
Mailing Address - Country:US
Mailing Address - Phone:786-608-8131
Mailing Address - Fax:
Practice Address - Street 1:301 HIALEAH DR APT 216
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-5260
Practice Address - Country:US
Practice Address - Phone:786-608-8131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-24
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-116332106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician