Provider Demographics
NPI:1821884859
Name:NELSON BLANCO, LISANDRA (RBT)
Entity type:Individual
Prefix:
First Name:LISANDRA
Middle Name:
Last Name:NELSON BLANCO
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 1:6008 W PARIS ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5147
Mailing Address - Country:US
Mailing Address - Phone:813-540-8151
Mailing Address - Fax:
Practice Address - Street 1:6008 W PARIS ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5147
Practice Address - Country:US
Practice Address - Phone:813-640-8151
Practice Address - Fax:813-640-8151
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-428081106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician