Provider Demographics
NPI:1861215774
Name:LEE, LARIANA HEAVEN
Entity type:Individual
Prefix:
First Name:LARIANA
Middle Name:HEAVEN
Last Name:LEE
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 1:19575 NW 29TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-2442
Mailing Address - Country:US
Mailing Address - Phone:786-992-4670
Mailing Address - Fax:
Practice Address - Street 1:19575 NW 29TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-2442
Practice Address - Country:US
Practice Address - Phone:786-992-4670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician