Provider Demographics
NPI:1164751459
Name:GEONIE, LIZA E (MSED, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:LIZA
Middle Name:E
Last Name:GEONIE
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18A VAN WICKLEN CT
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2139
Mailing Address - Country:US
Mailing Address - Phone:516-582-4361
Mailing Address - Fax:
Practice Address - Street 1:18A VAN WICKLEN CT
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2139
Practice Address - Country:US
Practice Address - Phone:516-582-4361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst