Provider Demographics
NPI:1902269574
Name:KADISON, LISA (BCBA)
Entity type:Individual
Prefix:MISS
First Name:LISA
Middle Name:
Last Name:KADISON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8525 HIDDEN RIVER PKWY
Mailing Address - Street 2:UNIT 201
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33637-1150
Mailing Address - Country:US
Mailing Address - Phone:813-957-7604
Mailing Address - Fax:
Practice Address - Street 1:8525 HIDDEN RIVER PKWY
Practice Address - Street 2:UNIT 201
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33637-1150
Practice Address - Country:US
Practice Address - Phone:813-957-7604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11519528103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst