Provider Demographics
NPI:1881454759
Name:CASOLA ALVAREZ, LISET (RBT)
Entity type:Individual
Prefix:
First Name:LISET
Middle Name:
Last Name:CASOLA ALVAREZ
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 1:7715 PALMBROOK DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2938
Mailing Address - Country:US
Mailing Address - Phone:813-900-1145
Mailing Address - Fax:
Practice Address - Street 1:7715 PALMBROOK DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2938
Practice Address - Country:US
Practice Address - Phone:813-900-1145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-328404106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician