Provider Demographics
NPI:1053195388
Name:LIRIANO, YESSICA
Entity type:Individual
Prefix:
First Name:YESSICA
Middle Name:
Last Name:LIRIANO
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 1:1912 BARNES AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-3271
Mailing Address - Country:US
Mailing Address - Phone:347-582-5014
Mailing Address - Fax:
Practice Address - Street 1:299 BROADWAY STE 905
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-1960
Practice Address - Country:US
Practice Address - Phone:917-873-1022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health