Provider Demographics
NPI:1376207159
Name:AGUILERA ABREU, LIANNE
Entity Type:Individual
Prefix:
First Name:LIANNE
Middle Name:
Last Name:AGUILERA ABREU
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 1:928 HARTH DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-3830
Mailing Address - Country:US
Mailing Address - Phone:561-603-5684
Mailing Address - Fax:
Practice Address - Street 1:928 HARTH DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-3830
Practice Address - Country:US
Practice Address - Phone:561-603-5684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103846300Medicaid