Individual
LISSETT ROMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2488 W 64TH PL, HIALEAH, FL 33016-4386
(305) 904-3806
Mailing address
2488 W 64TH PL, HIALEAH, FL 33016-4386
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
0-17-8017
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022456300
—
FL
Enumeration date
10/02/2017
Last updated
02/08/2022
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