Provider Demographics
NPI:1770597114
Name:CONDELLO, LIANA JOY (MA, LISAC, CCTP)
Entity type:Individual
Prefix:MISS
First Name:LIANA
Middle Name:JOY
Last Name:CONDELLO
Suffix:
Gender:F
Credentials:MA, LISAC, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36144
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740-6144
Mailing Address - Country:US
Mailing Address - Phone:520-548-8974
Mailing Address - Fax:
Practice Address - Street 1:3045 N 1ST AVE STE A
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2560
Practice Address - Country:US
Practice Address - Phone:520-548-8974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11765101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty