Provider Demographics
NPI:1992682926
Name:LISMA, KERVINS
Entity type:Individual
Prefix:
First Name:KERVINS
Middle Name:
Last Name:LISMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8395 W OAKLAND PARK BLVD. SUITE A
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351
Mailing Address - Country:US
Mailing Address - Phone:561-818-1367
Mailing Address - Fax:561-818-1367
Practice Address - Street 1:8395 W OAKLAND PARK BLVD STE A
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7301
Practice Address - Country:US
Practice Address - Phone:561-818-1367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician