Individual
AMBER LIVELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3915 W CARDINAL PINE DR, MASCOTTE, FL 34753-8861
(352) 636-8653
Mailing address
3915 W CARDINAL PINE DR, MASCOTTE, FL 34753-8861
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
FL
Other
Enumeration date
10/17/2022
Last updated
10/31/2022
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