Provider Demographics
NPI:1689400343
Name:ENAMORADO, LIANNE CARIDAD
Entity type:Individual
Prefix:
First Name:LIANNE
Middle Name:CARIDAD
Last Name:ENAMORADO
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 1:11502 ANNETTE AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33637-2704
Mailing Address - Country:US
Mailing Address - Phone:239-298-3902
Mailing Address - Fax:
Practice Address - Street 1:11502 ANNETTE AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33637-2704
Practice Address - Country:US
Practice Address - Phone:239-298-3902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-342541106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician