Provider Demographics
NPI:1649965013
Name:PERDOMO ALVAREZ, LIZA TAIRANIS (BEHAVIOR ASSISTANT)
Entity type:Individual
Prefix:MS
First Name:LIZA
Middle Name:TAIRANIS
Last Name:PERDOMO ALVAREZ
Suffix:
Gender:F
Credentials:BEHAVIOR ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20725 CRYSTAL HILL CIR APT A
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-3950
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20725 CRYSTAL HILL CIR APT A
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-3950
Practice Address - Country:US
Practice Address - Phone:340-643-8345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician