Provider Demographics
NPI:1447844147
Name:MONCALEANO, LISLEY NATALIA (RBT)
Entity type:Individual
Prefix:
First Name:LISLEY
Middle Name:NATALIA
Last Name:MONCALEANO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25350 SW 137TH AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-5661
Mailing Address - Country:US
Mailing Address - Phone:786-247-3951
Mailing Address - Fax:
Practice Address - Street 1:25350 SW 137TH AVE APT 303
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-5661
Practice Address - Country:US
Practice Address - Phone:786-247-3951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1999180106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician