Provider Demographics
NPI:1790508646
Name:DUARTE URIA, LISEL
Entity type:Individual
Prefix:
First Name:LISEL
Middle Name:
Last Name:DUARTE URIA
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 1:1225 W 35TH ST APT 55A
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-8605
Mailing Address - Country:US
Mailing Address - Phone:786-712-7024
Mailing Address - Fax:
Practice Address - Street 1:8001 W 26TH AVE UNIT 2B
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-2753
Practice Address - Country:US
Practice Address - Phone:786-360-2630
Practice Address - Fax:786-444-5578
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-380386106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician