Provider Demographics
NPI:1982427639
Name:LAZO ECHEVARRIA, SILENAY
Entity type:Individual
Prefix:
First Name:SILENAY
Middle Name:
Last Name:LAZO ECHEVARRIA
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 1:17718 NW 59TH AVE UNIT 104
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5143
Mailing Address - Country:US
Mailing Address - Phone:239-240-4005
Mailing Address - Fax:
Practice Address - Street 1:17718 NW 59TH AVE UNIT 104
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5143
Practice Address - Country:US
Practice Address - Phone:239-240-4005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-387783106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician