Individual
LERCY JANIRA AYALA COSME
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1413 WESTBURY DR, CLERMONT, FL 34711-7145
(407) 301-7475
Mailing address
1413 WESTBURY DR, CLERMONT, FL 34711-7145
(407) 301-7475
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
222Q00000X
Developmental Therapist
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
Other
Enumeration date
07/03/2018
Last updated
08/12/2021
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