Provider Demographics
NPI:1770340945
Name:CAMALLERE, XAYIDE LISET SR
Entity type:Individual
Prefix:MISS
First Name:XAYIDE
Middle Name:LISET
Last Name:CAMALLERE
Suffix:SR
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:XAYIDE
Other - Middle Name:LISET
Other - Last Name:CAMALLERE
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:RBT
Mailing Address - Street 1:5275NW 29THAVE
Mailing Address - Street 2:APARTMENT 806
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142
Mailing Address - Country:US
Mailing Address - Phone:786-633-9581
Mailing Address - Fax:
Practice Address - Street 1:5275NW 29TH AVE
Practice Address - Street 2:APARTMENT 806
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142
Practice Address - Country:US
Practice Address - Phone:786-633-9581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT23311856106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician