Provider Demographics
NPI:1255007993
Name:LIRIANO, PAOLA MARINA (RBT)
Entity Type:Individual
Prefix:
First Name:PAOLA
Middle Name:MARINA
Last Name:LIRIANO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 DRYDEN AVE
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-1339
Mailing Address - Country:US
Mailing Address - Phone:301-674-2421
Mailing Address - Fax:
Practice Address - Street 1:716 INDIAN TRL STE 140
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-5702
Practice Address - Country:US
Practice Address - Phone:254-213-2952
Practice Address - Fax:866-459-0530
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-21-179071103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty