MEDICARE: LIANET MARQUETTI LOPEZ BCBA

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	101Y00000X	Counselor
2	103K00000X	Behavior Analyst	LBA1037	NV

General Provider Information

NPI Number	:	1457896342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIANET MARQUETTI LOPEZ BCBA

Provider Business Mailing Address
First Line	:	5278 WILBUR ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-4854
Country	:	US
Telephone Number	:	725-200-9997
Fax Number	:

Provider Business Practice Location Address
First Line	:	4521 PALM MESA DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-4243
Country	:	US
Telephone Number	:	725-200-9997
Fax Number	:

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

Provider Enumeration Date	:	12/30/2016
Last Update Date	:	07/28/2025

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