Individual
LICET DORTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9234 SW 211TH LN, CUTLER BAY, FL 33189
(786) 800-0240
Mailing address
9234 SW 211TH LN, CUTLER BAY, FL 33189-3132
(786) 663-4948
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
0-19-10586
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021064800
—
FL
Enumeration date
10/19/2017
Last updated
08/14/2024
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