Healthcare Provider Details

I. General information

NPI: 1316664105
Provider Name (Legal Business Name): LIRIANO THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 MCELMURRAY RD
BEECH ISLAND SC
29842-8380
US

IV. Provider business mailing address

173 MCELMURRAY RD
BEECH ISLAND SC
29842-8380
US

V. Phone/Fax

Practice location:
  • Phone: 786-734-2777
  • Fax:
Mailing address:
  • Phone: 786-734-2777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PRICILLA LIRIANO
Title or Position: OWNER
Credential: LCSW
Phone: 786-734-2777