Provider Demographics
NPI:1316743107
Name:ALVAREZ-CORBERA, LISSETTE MARIE
Entity type:Individual
Prefix:
First Name:LISSETTE
Middle Name:MARIE
Last Name:ALVAREZ-CORBERA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6890 SW 89TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2430
Mailing Address - Country:US
Mailing Address - Phone:786-286-2699
Mailing Address - Fax:
Practice Address - Street 1:6890 SW 89TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2430
Practice Address - Country:US
Practice Address - Phone:786-286-2699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-306291106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty