Provider Demographics
NPI:1619585700
Name:CISNEROS, ARIANA RAQUEL
Entity Type:Individual
Prefix:
First Name:ARIANA
Middle Name:RAQUEL
Last Name:CISNEROS
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 1:8300 PIGEON FORK LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2930
Mailing Address - Country:US
Mailing Address - Phone:301-974-5890
Mailing Address - Fax:
Practice Address - Street 1:8300 PIGEON FORK LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-2930
Practice Address - Country:US
Practice Address - Phone:301-974-5890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician