Provider Demographics
NPI:1669059556
Name:RODRIGUEZ CABRERA, LIDICE
Entity type:Individual
Prefix:
First Name:LIDICE
Middle Name:
Last Name:RODRIGUEZ CABRERA
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 1:1100 PONDELLA RD APT 301
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-5152
Mailing Address - Country:US
Mailing Address - Phone:786-317-8121
Mailing Address - Fax:
Practice Address - Street 1:2853 SW 38TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33134-7343
Practice Address - Country:US
Practice Address - Phone:786-317-8121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-21-11832106E00000X
FL1-21-54370103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110153900Medicaid