Provider Demographics
NPI:1841944709
Name:RODRIGUEZ, LISSA ERENIA (BCABA-0-23-14414)
Entity type:Individual
Prefix:
First Name:LISSA
Middle Name:ERENIA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:BCABA-0-23-14414
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2069 SE 12TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33035-1939
Mailing Address - Country:US
Mailing Address - Phone:786-610-8535
Mailing Address - Fax:786-404-3781
Practice Address - Street 1:2069 SE 12TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33035-1939
Practice Address - Country:US
Practice Address - Phone:786-610-8535
Practice Address - Fax:786-404-3781
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-174573106S00000X
FLBCABA-0-23-14414106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician