Provider Demographics
NPI:1346633641
Name:WARANIS, ALICIA B
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:B
Last Name:WARANIS
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 1:74 IRWIN PL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-3902
Mailing Address - Country:US
Mailing Address - Phone:908-268-8455
Mailing Address - Fax:
Practice Address - Street 1:583 SHOEMAKER RD STE 230
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-4238
Practice Address - Country:US
Practice Address - Phone:484-681-2170
Practice Address - Fax:484-320-8307
Is Sole Proprietor?:No
Enumeration Date:2015-03-11
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-14-16942103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst