Basic Information
| Provider Information | |||||||||
| NPI: | 1508389727 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERRERA | ||||||||
| FirstName: | LIZETTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9330 BROADWAY ST STE 312 | ||||||||
| Address2: | |||||||||
| City: | PEARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775847895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328566241 | ||||||||
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| Practice Location | |||||||||
| Address1: | 453 KING ST | ||||||||
| Address2: | |||||||||
| City: | COCOA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329227621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3216335511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2017 | ||||||||
| LastUpdateDate: | 08/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 2355S0801X | 41186 | TX | Y | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant |
No ID Information.