Provider Demographics
NPI:1871915249
Name:GARCIA, KAREN LISSET
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LISSET
Last Name:GARCIA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3396 FLORIGOLD GROVE ST
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-9534
Mailing Address - Country:US
Mailing Address - Phone:407-616-0587
Mailing Address - Fax:
Practice Address - Street 1:2250 LUCIEN WAY STE 220
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7004
Practice Address - Country:US
Practice Address - Phone:407-616-0587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-20
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-14-16178103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018093000Medicaid