Provider Demographics
NPI:1912785544
Name:BERDAYES, LIZ
Entity Type:Individual
Prefix:
First Name:LIZ
Middle Name:
Last Name:BERDAYES
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 1:7155 NW 179TH ST APT 106
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-6112
Mailing Address - Country:US
Mailing Address - Phone:786-593-2288
Mailing Address - Fax:
Practice Address - Street 1:7155 NW 179TH ST APT 106
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-6112
Practice Address - Country:US
Practice Address - Phone:786-593-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-293873106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician