Basic Information
| Provider Information | |||||||||
| NPI: | 1770029738 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIZEMORE | ||||||||
| FirstName: | SCLENA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 722 PARROT CT | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347594535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5856226519 | ||||||||
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| Practice Location | |||||||||
| Address1: | 145 E EDGEWOOD DR | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338034014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636192809 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2017 | ||||||||
| LastUpdateDate: | 01/16/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 0-16-7330 | FL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.