Provider Demographics
NPI:1164292991
Name:FONT GRANADOS, LILIAGNE
Entity Type:Individual
Prefix:
First Name:LILIAGNE
Middle Name:
Last Name:FONT GRANADOS
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 1:3205 43RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-4450
Mailing Address - Country:US
Mailing Address - Phone:786-685-1164
Mailing Address - Fax:
Practice Address - Street 1:3205 43RD AVE NE
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34120-4450
Practice Address - Country:US
Practice Address - Phone:786-685-1164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician