Provider Demographics
NPI:1437616893
Name:MEDINA LIRIANO, MAYERLING
Entity Type:Individual
Prefix:
First Name:MAYERLING
Middle Name:
Last Name:MEDINA LIRIANO
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 1:626 SW 21ST CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-4627
Mailing Address - Country:US
Mailing Address - Phone:561-444-6460
Mailing Address - Fax:
Practice Address - Street 1:626 SW 21ST CIR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-4627
Practice Address - Country:US
Practice Address - Phone:561-444-6460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-23-14851106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst