Provider Demographics
NPI:1265732077
Name:RICARDO, LIA L (SPECIAL ED TEACHER)
Entity type:Individual
Prefix:MRS
First Name:LIA
Middle Name:L
Last Name:RICARDO
Suffix:
Gender:F
Credentials:SPECIAL ED TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 207TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1349
Mailing Address - Country:US
Mailing Address - Phone:718-423-1796
Mailing Address - Fax:
Practice Address - Street 1:2307 207TH ST
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1349
Practice Address - Country:US
Practice Address - Phone:718-423-1796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1475572103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1475572OtherNEW YORK STATE EDUCATION DEPARTMENT
26438OtherSTATE OF NEW YORK DEPARTMENT OF HEALTH