Provider Demographics
NPI:1346745858
Name:PRAICO, LIANNE
Entity Type:Individual
Prefix:
First Name:LIANNE
Middle Name:
Last Name:PRAICO
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 1:1956 NIGHTINGALE AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95205-7761
Mailing Address - Country:US
Mailing Address - Phone:209-982-1928
Mailing Address - Fax:
Practice Address - Street 1:1956 NIGHTINGALE AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205-7761
Practice Address - Country:US
Practice Address - Phone:209-982-1928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician