Provider Demographics
NPI:1750104956
Name:SOSA GARCIA, LISA MARIE (RBT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:SOSA GARCIA
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 1:6251 W FLAGLER ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-3027
Mailing Address - Country:US
Mailing Address - Phone:786-413-5484
Mailing Address - Fax:
Practice Address - Street 1:13499 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2043
Practice Address - Country:US
Practice Address - Phone:786-413-5484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-208151106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician