Provider Demographics
NPI:1952750754
Name:BALLATE, LISDY
Entity Type:Individual
Prefix:
First Name:LISDY
Middle Name:
Last Name:BALLATE
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 1:3900 SW 88TH PL
Mailing Address - Street 2:APT 18
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-5476
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3900 SW 88TH PL
Practice Address - Street 2:APT 18
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-5476
Practice Address - Country:US
Practice Address - Phone:786-773-4404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst