Provider Demographics
NPI:1447070610
Name:CONCEPCION, PRISCILLA LIZMAR
Entity type:Individual
Prefix:MISS
First Name:PRISCILLA
Middle Name:LIZMAR
Last Name:CONCEPCION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 SUMMER HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-4828
Mailing Address - Country:US
Mailing Address - Phone:407-219-1957
Mailing Address - Fax:
Practice Address - Street 1:2410 SUMMER HOLLOW DR
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-4828
Practice Address - Country:US
Practice Address - Phone:407-219-1957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician