Provider Demographics
NPI:1669229563
Name:HORTA-FERNANDEZ, LISMARY
Entity type:Individual
Prefix:
First Name:LISMARY
Middle Name:
Last Name:HORTA-FERNANDEZ
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 1:300 NE 1ST ST APT 15
Mailing Address - Street 2:
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-3172
Mailing Address - Country:US
Mailing Address - Phone:786-531-1331
Mailing Address - Fax:
Practice Address - Street 1:237 TAM O SHANTER DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-1906
Practice Address - Country:US
Practice Address - Phone:561-667-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT24343278103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst