Provider Demographics
NPI:1881457802
Name:PEREZ NODA, LISANDRA (RBT)
Entity type:Individual
Prefix:
First Name:LISANDRA
Middle Name:
Last Name:PEREZ NODA
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 1:13360 SW 52ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-5218
Mailing Address - Country:US
Mailing Address - Phone:786-868-6363
Mailing Address - Fax:
Practice Address - Street 1:12150 SW 128TH CT STE 125
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4672
Practice Address - Country:US
Practice Address - Phone:305-964-5191
Practice Address - Fax:786-250-3038
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-324518106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician