Individual
MISS LISA QUEENESTER MARONEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
320 AUTUMN PARK, FORT WORTH, TX 76140-6524
(817) 565-5984
Mailing address
320 AUTUMN PARK, FORT WORTH, TX 76140-6524
(817) 565-5984
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
253J00000X
Foster Care Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
01/15/2009
Last updated
01/15/2009
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