Provider Demographics
NPI:1174906127
Name:LAVIENA, QIANA
Entity type:Individual
Prefix:
First Name:QIANA
Middle Name:
Last Name:LAVIENA
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:PO BOX 2468
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-9268
Mailing Address - Country:US
Mailing Address - Phone:973-913-4103
Mailing Address - Fax:
Practice Address - Street 1:377 DODD ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-1701
Practice Address - Country:US
Practice Address - Phone:973-913-4103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator