Provider Demographics
NPI:1699540104
Name:GORDILLO ACOSTA, LIANET (RBT)
Entity type:Individual
Prefix:
First Name:LIANET
Middle Name:
Last Name:GORDILLO ACOSTA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8002 SW 149TH AVE APT B104
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1462
Mailing Address - Country:US
Mailing Address - Phone:786-916-7427
Mailing Address - Fax:
Practice Address - Street 1:8002 SW 149TH AVE APT B104
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-1462
Practice Address - Country:US
Practice Address - Phone:786-916-7427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-15
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-304641106S00000X
FLRBT-23-304661103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician