Provider Demographics
NPI:1033711650
Name:RIFE, LILLIAN RAIN (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:RAIN
Last Name:RIFE
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 STANDIFORD AVE STE 12-180
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-6522
Mailing Address - Country:US
Mailing Address - Phone:916-903-8465
Mailing Address - Fax:
Practice Address - Street 1:2100 STANDIFORD AVE STE 12-180
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-6522
Practice Address - Country:US
Practice Address - Phone:559-390-5143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-21-53212103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst