Provider Demographics
NPI:1972660207
Name:ROA, DORCAS LIRIANO (PHD)
Entity Type:Individual
Prefix:DR
First Name:DORCAS
Middle Name:LIRIANO
Last Name:ROA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:DORCAS
Other - Middle Name:E
Other - Last Name:LIRIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2825 50TH ST
Mailing Address - Street 2:M.I.N.D. INSTITUTE
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2308
Mailing Address - Country:US
Mailing Address - Phone:916-703-0267
Mailing Address - Fax:
Practice Address - Street 1:2825 50TH ST
Practice Address - Street 2:M.I.N.D. INSTITUTE
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2308
Practice Address - Country:US
Practice Address - Phone:916-703-0267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21310103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP086604OtherBCBS
MA1854704OtherMASSHEALTH
MAW15207Medicare UPIN