Provider Demographics
NPI:1386311488
Name:JUAREZ, LIZZETTE (RBT)
Entity type:Individual
Prefix:
First Name:LIZZETTE
Middle Name:
Last Name:JUAREZ
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7425 WESTFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-3056
Mailing Address - Country:US
Mailing Address - Phone:317-918-2689
Mailing Address - Fax:
Practice Address - Street 1:29101 N STATE ROAD 19
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:IN
Practice Address - Zip Code:46031-9443
Practice Address - Country:US
Practice Address - Phone:317-918-2689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-21-180152106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician