Provider Demographics
NPI:1427503507
Name:ACADEMIC, BEHAVIORAL, AND COGNITIVE TESTING SERVICES LLC
Entity type:Organization
Organization Name:ACADEMIC, BEHAVIORAL, AND COGNITIVE TESTING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ LICENSED AND NATIONALLY CER
Authorized Official - Prefix:
Authorized Official - First Name:LISETTE
Authorized Official - Middle Name:D
Authorized Official - Last Name:RIERA
Authorized Official - Suffix:
Authorized Official - Credentials:PSY S, LSP, NCSP
Authorized Official - Phone:786-529-8378
Mailing Address - Street 1:7001 SW 97TH AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1410
Mailing Address - Country:US
Mailing Address - Phone:786-529-8378
Mailing Address - Fax:786-400-2134
Practice Address - Street 1:7001 SW 97TH AVE STE 206
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1410
Practice Address - Country:US
Practice Address - Phone:786-529-8378
Practice Address - Fax:786-400-2134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018936900Medicaid
FL13878294OtherCAQH