MEDICARE: LIANA KATHERINE PANIK LBS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst	BH007261	PA

General Provider Information

NPI Number	:	1891566428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIANA KATHERINE PANIK LBS

Provider Business Mailing Address
First Line	:	922 N 17TH ST UNIT C
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-1771
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 HAMILTON ST STE C100A
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-3863
Country	:	US
Telephone Number	:	856-346-0005
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2024
Last Update Date	:	10/16/2024

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