Provider Demographics
NPI:1770123846
Name:SHUMAKE, LISA MARIE (RBT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:SHUMAKE
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4629 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32583-4107
Mailing Address - Country:US
Mailing Address - Phone:505-036-6368
Mailing Address - Fax:850-626-6132
Practice Address - Street 1:4629 CHURCH ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32583-4107
Practice Address - Country:US
Practice Address - Phone:850-503-6636
Practice Address - Fax:850-626-6132
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-109408106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician