Provider Demographics
NPI:1669859757
Name:PILDIS, LIANNA (MA, BCBA)
Entity Type:Individual
Prefix:MS
First Name:LIANNA
Middle Name:
Last Name:PILDIS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OAK AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-3052
Mailing Address - Country:US
Mailing Address - Phone:203-530-1881
Mailing Address - Fax:
Practice Address - Street 1:100 OAK AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-3052
Practice Address - Country:US
Practice Address - Phone:203-530-1881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst