Provider Demographics
NPI:1790528917
Name:PIQUERA CHAOS, ANNALIE DANAY
Entity type:Individual
Prefix:
First Name:ANNALIE
Middle Name:DANAY
Last Name:PIQUERA CHAOS
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 1:626 BEVERLY PL
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33974-4765
Mailing Address - Country:US
Mailing Address - Phone:239-565-9348
Mailing Address - Fax:
Practice Address - Street 1:626 BEVERLY PL
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33974-4765
Practice Address - Country:US
Practice Address - Phone:239-565-9348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-15
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-352215106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician