Provider Demographics
NPI:1073341343
Name:GONZALEZ REYES, LISMERIS (RBT-24-361976)
Entity type:Individual
Prefix:
First Name:LISMERIS
Middle Name:
Last Name:GONZALEZ REYES
Suffix:
Gender:F
Credentials:RBT-24-361976
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 WHITE BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-8618
Mailing Address - Country:US
Mailing Address - Phone:678-524-1982
Mailing Address - Fax:
Practice Address - Street 1:134 WHITE BIRCH DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-8618
Practice Address - Country:US
Practice Address - Phone:678-524-1982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-361976106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician