Provider Demographics
NPI:1538054333
Name:DOSAL GUZMAN, LISSETT
Entity type:Individual
Prefix:
First Name:LISSETT
Middle Name:
Last Name:DOSAL GUZMAN
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 1:9441 SW 4TH ST APT 204
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2018
Mailing Address - Country:US
Mailing Address - Phone:786-806-5194
Mailing Address - Fax:
Practice Address - Street 1:2075 W 76TH ST UNIT 1
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1834
Practice Address - Country:US
Practice Address - Phone:786-558-5261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-139202106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician